Management of perforated duodenal diverticula.

Cavernous hemangiomas most commonly affect the skin and liver, with the first report of adrenal involvement published in 1955. Adrenal hemangiomas remain rare, with fewer than 40 reported cases. Cavernous adrenal hemangiomas, usually unilateral, become apparent in the sixth to seventh decade of life, with a 2:1 female-to-male predilection. These lesions usually become apparent as incidental radiological findings or as a result of nondescript pressureand mass-related symptoms. Instances of adrenal hyperfunction are almost nonexistent, with only 1 reported case of adrenocortical hypersecretion. Clinically significant hemorrhage is extremely rare; no instances of spontaneous bleeding have previously been reported. In the few reported cases, distinct radiographic features have helped distinguish cavernous hemangiomas from more common adrenal neoplasms. In up to twothirds of cases, plain radiographs show speckled calcification throughout the entire neoplasm. Contrast-enhanced CT has displayed a characteristic peripheral patchy enhancement and highly dense peripheral rim. Angiography reveals peripheral pooling of contrast that persists well into the venous phase of the study. Although the massive hemorrhage that occurred with this case is unusual, there are other indications for resection of this rare neoplasm. The most common reported indications for elective resection are to relieve mass-effect-type symptoms and to exclude malignancy. As the differential diagnosis of these lesions include hemangiosarcoma and hemangioblastoma as well as hemangioma, most would agree that these lesions should be resected to exclude malignancy. Spontaneous hemorrhage appears to be an unusual complication, not previously reported, but whose prevention can be listed as another indication for elective resection of these rare neoplasms.