Collision tumors are uncommon neoplasms composed of two histologically distinct tumor populations occurring within the same anatomic site while maintaining separate boundaries. Pancreatic collision tumors composed of solid pseudopapillary neoplasm (SPN) and well-differentiated pancreatic neuroendocrine tumor (PanNET) are rare and may be diagnostically challenging because these entities can show overlapping morphologic and immunophenotypic features and may radiographically present as a single lesion. A 41-year-old woman presented with left upper quadrant abdominal pain and was found to have a pancreatic head mass. Fine-needle aspiration favored SPN, and the patient underwent extended pancreaticoduodenectomy. Histologic examination demonstrated a 3.7 cm SPN and an adjacent 0.6 cm World Health Organization grade 1 PanNET, separated by an abrupt interface without appreciable intermingling. Immunohistochemistry showed nuclear β-catenin and cyclin D1 expression in the SPN, while the PanNET showed diffuse chromogranin and INSM1 expression with retained membranous E-cadherin. Synaptophysin was positive in both tumors, highlighting a diagnostic pitfall. Eighteen lymph nodes were negative for metastatic disease, and both tumors were confined to the pancreas. This case represents the fourth reported pancreatic SPN-WDNET collision tumor and highlights important diagnostic and classification challenges in pancreatic neoplasms that demonstrate dual differentiation. Because SPNs may exhibit partial neuroendocrine differentiation, neuroendocrine marker positivity alone should not be used to establish a diagnosis of WDNET in the setting of SPN. Instead, accurate classification requires careful integration of histomorphology and complementary immunophenotypic findings.

Splenic rupture most commonly results from blunt abdominal trauma or splenomegaly associated with infection. Diagnosing splenic injury during pregnancy is particularly challenging because its clinical signs and symptoms overlap with those of other common causes of acute abdominal pain in pregnancy. We report the case of a previously healthy 25-year-old woman (gravida 6, para 2, abortions 3, living 2) at 28 weeks and 5 days of gestation who presented with the acute onset of left upper quadrant (LUQ) abdominal pain. She had sustained mild direct abdominal trauma, followed by three weeks of progressively worsening left-sided chest pain radiating to the shoulder. Clinical evaluation and imaging revealed hemorrhagic shock and hemoperitoneum secondary to splenic injury. The patient underwent a successful exploratory laparotomy and splenectomy, during which a splenic laceration was identified. Postoperatively, she was diagnosed with infectious mononucleosis and subsequently had an uncomplicated full-term delivery. This case highlights the importance of thorough evaluation of acute abdominal pain during pregnancy and demonstrates that splenectomy can be safely performed during the third trimester when clinically indicated.

Background/Objectives: Primary splenic pregnancy (PSP) is a rare and life-threatening form of extrauterine pregnancy. Evidence is limited to case reports, and detailed analyses of all aspects of PSP are lacking. The objective is to review and summarize the clinical features, diagnostic methods, management strategies, and maternal outcomes of PSP. Methods: Review followed PRISMA 2020 guidelines. We conducted a literature search to identify all published reports of PSP in PubMed, PubMed Central, and Google Scholar published until September 2025. The search items included: 'splenic pregnancy', 'splenic ectopic pregnancy', 'ectopic pregnancy', 'pregnancy', and 'spleen'. Additional studies were identified by reviewing the reference lists of retrieved studies. We included all available full-text cases, with the inclusion criterion being PSP and the exclusion criterion being secondary splenic pregnancy. The data on clinical presentation, diagnostics, management, and outcomes were extracted and summarized descriptively. Results: Sixty published cases of PSP were collected. The average maternal age was 30.3 years, and most cases were reported in Asia. No consistent pattern of potential risk factors was observed; cases occurred between 4 and 14 weeks of gestation. Abdominal pain was the most common symptom (86.7%), often localized to the left upper quadrant. Hypotension and hemoperitoneum were present in 41.7% and 60.0% of cases, respectively. Ultrasound was the most used initial imaging modality, whereas CT and MRI showed high concordance with the final diagnosis. Most implantations occurred on the inferior and superior poles of the spleen. Surgical intervention was the predominant approach (90%), primarily involving laparotomy with splenectomy or partial splenectomy. Antibiotic use was rarely documented. Medical management was reported in selected cases, but no βhCG threshold for PSP can be inferred. Maternal survival was almost universal; the single reported death occurred in the earliest case. Conclusions: PSP should be excluded when left-sided abdominal pain, particularly with intra-abdominal bleeding, accompanies an empty uterus and elevated βhCG. No reliable βhCG threshold for treatment selection has been established, and management should be individualized based on clinical condition, diagnostic imaging, and available expertise, based on low level of evidence. Although maternal survival is excellent, spleen-preserving and non-surgical approaches remain rare.

Wandering spleen is a rare clinical entity characterized by abnormal displacement of the spleen from its normal anatomical position in the left upper quadrant. It may lead to serious complications such as torsion and infarction. Due to nonspecific clinical presentation, diagnosis can be challenging and imaging plays a crucial role. We present the case of a 20-year-old woman who presented with abdominal pain and was found to have a large pelvic mass initially suspected to be an ovarian germ cell tumor. Preoperative imaging demonstrated absence of the spleen in the left upper quadrant and a solid pelvic mass. Intraoperative findings revealed an ectopic spleen, which was confirmed histopathologically. This case highlights the importance of considering wandering spleen in the differential diagnosis of pelvic masses in young women, particularly when the spleen is not visualized in its normal location.

Situs inversus totalis (SIT) is a rare congenital laterality anomaly characterized by the complete mirror-image transposition of the thoracic and abdominal viscera. Although it is usually asymptomatic, the occurrence of acute biliary disease poses significant diagnostic and surgical challenges because the atypical location of pain and reversed anatomy may complicate clinical assessment, interpretation of imaging studies, and laparoscopic planning. We present the case of a patient with acute biliary pancreatitis associated with acute calculous cholecystitis in the setting of SIT, whose management required individualized diagnostic evaluation and surgical planning tailored to the mirror-image anatomy. A 20-year-old woman with a known diagnosis of SIT presented with a three-day history of severe epigastric pain radiating to the left upper quadrant and back, accompanied by nausea and vomiting. Laboratory evaluation demonstrated markedly elevated pancreatic enzyme levels, mild hyperbilirubinemia, and elevated liver transaminases. Abdominal ultrasonography revealed cholelithiasis and findings suggestive of SIT. Contrast-enhanced computed tomography confirmed dextrocardia, complete visceral transposition, acute pancreatitis with peripancreatic inflammatory changes, and imaging findings consistent with acute calculous cholecystitis without biliary ductal dilatation. Based on the Revised Atlanta Classification, the patient was diagnosed with mild acute biliary pancreatitis. Following clinical stabilization, laparoscopic cholecystectomy was successfully performed using a mirror-image trocar configuration adapted from the conventional technique. The postoperative course was uneventful, and histopathological examination confirmed chronic cholecystitis associated with cholelithiasis. SIT is not a contraindication to laparoscopic cholecystectomy in patients with acute biliary disease; however, it requires early recognition of the mirror-image anatomy, accurate interpretation of imaging findings, and individualized surgical planning. In this setting, mirror-image trocar placement and strict adherence to the critical view of safety are essential to minimize the risk of bile duct injury. This case demonstrates that, with meticulous preoperative anatomical assessment and an individualized surgical strategy, laparoscopic management can be performed safely and effectively.

Background and Clinical Significance: The primary occurrence of low-grade endometrial stromal sarcoma (LG-ESS) at extrauterine sites, termed extrauterine ESS (EESS), is exceedingly rare. Case Presentation: A 49-year-old female, gravida 2 para 2 (all deliveries by cesarean section), presented with a 1-month history of epigastric and left upper quadrant abdominal pain. Abdominal computed tomography revealed a lobulated mass, measuring 4.6 cm, in the left upper quadrant with focal attachment to the splenic flexure of the colon. She underwent a laparoscopic partial gastrectomy and colectomy at a referral institution. Surgical pathology identified a 6.0 × 5.0 × 4.0 cm lobulated tumor involving the stomach with colonic invasion, diagnosed as LG-ESS (pT3N0). Immunohistochemistry showed a CD10-reactive lesion. The patient was referred to our institution for definitive gynecological surgery. After prophylactic ureteral double-J catheter insertion, she underwent laparoendoscopic single-site (LESS) total hysterectomy with bilateral salpingo-oophorectomy. The final histopathological examination of the hysterectomy specimen revealed intramural leiomyomas and benign ovarian cysts, with no evidence of ESS within the uterine corpus or adnexa. These findings confirmed a true primary EESS of nonuterine origin, consistent with AJCC stage 3 disease. The patient recovered uneventfully and was discharged during outpatient follow-up. Conclusions: This case represents one of the very few reported instances of primary LG-EESS involving the stomach and colon, simultaneously managed with a staged multidisciplinary surgical approach, including gastrointestinal resection followed by LESS hysterectomy and bilateral salpingo-oophorectomy.

Acute cholangitis is a potentially life-threatening infection of the biliary tract that usually results from biliary obstruction, most commonly secondary to choledocholithiasis. Although prompt diagnosis and treatment often lead to favorable outcomes, uncommon complications such as pylephlebitis (septic thrombosis of the portal vein) may significantly increase morbidity and mortality. We report the case of a 47-year-old woman with no significant past medical history who presented with right upper quadrant abdominal pain, fever (38.2°C), asthenia, and nausea. Physical examination revealed diffuse abdominal tenderness and mild jaundice. Abdominal point-of-care ultrasound (POCUS) made by the emergency physician on call showed multiple gallbladder calculi with sludge but without visible biliary dilatation. Laboratory evaluation demonstrated an inflammatory syndrome with C-reactive protein of 72 mg/L, normal leukocyte count, total bilirubin of 87 IU/L, and direct bilirubin of 56 IU/L, and cholestatic liver enzyme abnormalities, including alkaline phosphatase (ALP) of 190 IU/L and gamma-glutamyl transferase (GGT) of 108 IU/L. The diagnosis of acute angiocholitis was thus suspected. Abdominal imaging (computed tomography (CT) with contrast) showed intrahepatic and extrahepatic biliary dilatation caused by a distal common bile duct stone, multiple gallbladder calculi, and segment II left portal vein thrombosis consistent with pylephlebitis. A diagnosis of acute cholangitis secondary to choledocholithiasis complicated by pylephlebitis was established. The patient was treated with intravenous (IV) antibiotics, fluid resuscitation, and supportive care, with planned biliary decompression and definitive surgical management. This case highlights a rare but serious vascular complication of biliary stone disease. Clinicians should maintain a high index of suspicion for portal venous involvement in patients with cholangitis and persistent systemic symptoms. Early imaging, timely antimicrobial therapy, and coordinated multidisciplinary management are essential to reduce the risk of severe complications and improve outcomes.

Splenic abscess secondary to Actinomyces species is an exceedingly rare condition that presents with a constellation of nonspecific symptoms often leading to delayed presentation, diagnostic uncertainty, and misidentification. While Actinomyces is typically an indolent infection, splenic abscess has a high mortality when untreated due to the risk of splenic rupture. This case report highlights a rare instance of isolated Actinomyces splenic abscess in a 52-year-old man with a history of intravenous drug use, hepatitis C, and recent incarceration who presented with several weeks of hemoptysis, fevers, night sweats, pleuritic chest pain, and left upper quadrant abdominal pain. The history and clinical presentation were most concerning for malignancy, tuberculosis, or other pulmonary infectious etiologies. Computed tomography imaging revealed a 14.9 x 7.7 x 12.1 cm splenic abscess with associated pleural effusion. A percutaneous drain was placed by interventional radiology, and the resulting fluid culture grew Actinomyces meyeri. In consultation with infectious disease specialists, prolonged antibiotic therapy was started with four weeks of intravenous piperacillin-tazobactam followed by six months of oral amoxicillin. This case highlights both the diagnostic challenge of splenic actinomycosis and the importance of maintaining a broad differential diagnosis to avoid anchoring bias or early diagnostic closure in high-risk patients with nonspecific symptoms.

Cecal volvulus is a rare cause of large bowel obstruction with cecal bascule being a rare cause of cecal volvulus. We present a case of cecal bascule in a 27-year-old female with Kartagener's syndrome and complete situs inversus with no history of prior abdominal surgeries. Computed tomography imaging revealed complete heterotaxia of the intra-abdominal organs with displacement of the cecum to the left upper quadrant with anteromedial rotation concerning for cecal bascule. The patient was taken urgently to the operating room where an upper midline laparotomy was performed. The cecum was found to be edematous with a distinct area of obstruction consistent with radiographic findings and an ileocecectomy was performed. Recognition of rare diagnoses can be rendered even more difficult in a patient with complete situs inversus and requires a high index of suspicion.