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Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.

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A 57-year-old woman was found at home in quiet coma secondary to a deliberate insulin glargine injection. Due to the persistent hypoglycemia, she was referred to the ICU where she remained hypoglycemic for seven days. The patient presented recurrent episodes of hypoglycemia, even after day 7 and she received a total of 587 g of dextrose. Few data are available concerning the management of intoxication by long-lasting insulin. Our case illustrates the critical importance of admitting such patients in ICU for both close monitoring of blood sugar and dextrose administration. We discuss the discrepancy between the in vitro half-life of the insulin and the actual half-life with a "reservoir effect". Eventually, we compare our case with the casestudies in the literature and summarize the review of those published cases.