A rare lesion, macroscopic hemobilia involving the liver, is usually of traumatic or iatrogenic origin. A review of the international literature published between 1976 and 1981 demonstrated 73 such cases, including 50 of an iatrogenic nature. Among the diagnostic investigations employed, duodenal fibroscopy gave negative results in 50% of cases. Ultrasonography and computed tomography are now replacing scintigraphy with99mtechnetium as a diagnostic procedure for intrahepatic fluid collections. The most reliable method is arteriography, this alone providing both diagnostic and topographic data. The fact that treatment by endovascular route was successful in 24 of the 28 patients suggests that the need for surgery requires reconsideration, particularly in cases of iatrogenic origin.

We report a series of 30 patients with pancreatic insulinoma treated from 1967 to 1990. Twenty-nine patients underwent surgery. In 24 patients, the lesion was a benign adenoma. The pancreatic lesion was localized preoperatively in 59% of cases (94% since 1980), and all lesions that were identifiable histologically were palpable intraoperatively. Endoscopic pancreatic ultrasonography, performed twice, appeared to be a very promising method of investigation. In the 24 patients with adenoma, 14 enucleations and 10 pancreatic resections were performed, with the enucleation rate increasing over time. One patient died during the postoperative period. Pancreatic fistulas (43%) were the most common cause of morbidity and were more common after enucleation (57% versus 29% after pancreatectomy). The mean follow-up period was 7 years. Excluding the patients with adenocarcinomas, the recovery rate was 92% (23 of 25 among whom 2 patients had transitory recurrent hypoglycemia), 2 patients who underwent corporeo-caudal pancreatectomy being diabetic (8%).

In 1958, Caroli [1, 2] was the first to describe congenital dilatations of intrahepatic bile ducts concerning a segment, a sector, a lobe, or both halves of the liver. Sometimes the dilatations are associated with congenital hepatic fibrosis as described in 1954 by Grumbach [3], dilatations of biliary ductules (biliary angiomatosis), and parenchymal sclerosis. This hereditary autosomal recessive disease is associated in many cases with nephrospongiosis or Cacchi‐Ricci's disease [4]. Caroli's disease is quite rare. By 1982, a total of 99 cases had been reported in the world literature. Aside from these cases we have seen and operated on 10 patients [5, 6]. In Caroli's disease, stenosis and dilatations give rise initially to biliary stasis and, secondly, to intrahepatic biliary lithiasis and biliary infection. The normal course in Caroli's disease consists of suppurative cholangitis, septicemia with gram‐negative organisms, and intrahepatic and subphrenic abscesses. The disease must be recognized before these serious complications arise. The new hepatobiliary imaging procedures should now allow an early diagnosis and, therefore, a better therapeutic approach.