Atraumatic splenic rupture (ASR) is a rare but life-threatening surgical emergency that most commonly occurs in pathologically abnormal spleens. We present a unique case of ASR in a middle-aged man with recent use of performance-enhancing compounds, managed with both embolization and surgery. This case highlights an unusual potential contributing risk factor and underscores the importance of prompt diagnosis and definitive management of ASR. A 54-year-old male presented to the emergency department with acute left upper quadrant abdominal pain and vomiting. Notably, he had recently been using MK-677 (ibutamoren), a growth hormone secretagogue, and RAD-140 (testolone), a selective androgen receptor modulator (SARM), for bodybuilding purposes. The patient denied any history of trauma. Computed tomography revealed a large perisplenic hematoma consistent with splenic rupture. Following initial resuscitation, emergent splenic artery embolization was performed to control hemorrhage. This intervention stabilized the patient transiently; however, he ultimately required an emergency laparotomy with total splenectomy. Histopathological examination demonstrated large areas of splenic infarction, with features raising the possibility of an underlying vascular malformation.  These findings underscore the importance of recognising ASR in patients with acute abdominal pain and vascular risk factors. We explore the potential and speculative role of performance-enhancing compounds in precipitating splenic complications, drawing parallels to the established association between traditional anabolic steroids and peliosis - blood-filled vascular cavities that predispose to rupture. While RAD-140 and MK-677 have not been previously linked to splenic pathology, their pharmacological effects on androgen receptor signalling and IGF-1 pathways warrant consideration as possible contributing factors, particularly in the context of a suspected pre-existing vascular malformation. Early recognition, aggressive resuscitation, and timely surgical intervention remain critical, as delayed diagnosis carries significant mortality.

A 39-year-old man from an echinococcosis-endemic region presented with acute left upper quadrant pain. Imaging revealed cholelithiasis, a hepatic and a large abdominal cystic masses, and significant free peritoneal fluid. Urgent laparotomy unexpectedly disclosed three concurrent pathologies: chronic calculous cholecystitis, a perforated hepatic hydatid cyst, and an intact omental hydatid cyst. The exact source of his symptoms remains uncertain. This case highlighted the diagnostic challenge of coexisting surgical diseases in endemic regions.

Granulocyte-colony stimulating factor (G-CSF) is widely used to mobilize peripheral blood stem cells (PBSCs) for hematopoietic cell transplantation (HCT). G-CSF is generally well-tolerated but can cause life-threatening complications such as splenic rupture in rare cases. Long-acting pegfilgrastim (Peg-G) is increasingly used for PBSC mobilization, but its risk for splenic rupture is less well characterized. Here, we report a case of splenic rupture secondary to Peg-G administered for PBSC mobilization in a healthy 25-year-old male haploidentical donor. He presented with left upper quadrant abdominal pain shortly after PBSC harvest 5 days following administration of Peg-G. Computed tomography (CT) revealed splenomegaly with rupture, and small bloody peri-splenic and pelvic ascites. He was managed conservatively, but the next evening his symptoms temporarily worsened, prompting a repeat CT scan, which showed no change. Thereafter, the pain did not recur, and the patient was discharged on day 8. One month later, a follow-up CT demonstrated complete resolution. To our knowledge, this is the first case of splenic rupture secondary to Peg-G for PBSC mobilization in a healthy allogeneic donor and highlights the importance of vigilance for this rare complication when G-CSF or Peg-G is used for mobilization.

Wandering spleen is a rare condition caused by lax or absent splenic ligaments, which allows abnormal splenic mobility and predisposes the organ to torsion and infarction. Clinical presentation is often nonspecific, making imaging crucial for diagnosis. We report a 27-year-old woman who presented with a 5-day history of acute left upper quadrant abdominal pain radiating to the left shoulder, accompanied by nausea and constipation. Laboratory investigations revealed leukocytosis with neutrophil predominance, lymphopenia, and markedly elevated C-reactive protein and lactate dehydrogenase. Contrast-enhanced CT revealed an ectopic spleen with minimal enhancement and a whirl-sign of the twisted vascular pedicle. Laparotomy confirmed torsion with infarction, and splenectomy was performed. This case highlights the diagnostic challenge of wandering spleen and the critical role of contrast-enhanced CT in identifying torsion. Prompt recognition and surgical intervention are essential to prevent infarction and life-threatening complications.

Atraumatic splenic rupture is a rare but potentially life-threatening complication of pancreatic disease. This report describes the case of a 62-year-old man with a prior history of chronic pancreatitis related to alcoholic pancreatitis who presented with left upper abdominal pain without any history of trauma. Contrast-enhanced computed tomography demonstrated splenomegaly, a large splenic laceration, and a perisplenic hematoma without active contrast extravasation, along with a pancreatic cystic lesion and narrowing of the splenic vein. Magnetic resonance imaging showed heterogeneous signal intensity within the spleen, and a neoplastic lesion could not be excluded. On admission, serum amylase was mildly elevated at 149 U/L, HbA1c was 4.8%, and formal pancreatic exocrine function testing had not been performed before surgery. Because he was hemodynamically stable, conservative management was initially selected. However, persistent diagnostic uncertainty and concern for re-bleeding led to surgery on hospital day 9. Distal pancreatectomy with splenectomy and partial diaphragmatic resection was performed. Intraoperatively, the pancreas was indurated, consistent with chronic inflammatory change. Histopathological examination of the resected distal pancreas demonstrated chronic pancreatitis with fibrosis, mild chronic inflammatory cell infiltration, fat necrosis, pseudolobular formation, and focal acute inflammation, with no evidence of malignancy. The final diagnosis was atraumatic splenic rupture secondary to splenic vein thrombosis associated with chronic pancreatitis. This case highlights the need to consider splenic complications in patients with chronic pancreatitis who present with left upper quadrant pain and supports surgical management when malignancy cannot be excluded or when the risk of re-bleeding remains a concern.

Wandering spleen (WS) is a rare congenital anomaly characterized by abnormal mobility of the spleen due to laxity of the splenic suspensory ligaments. WS can result in complications such as torsion, infarction, and involvement of adjacent structures including the pancreas. This report details a unique case of WS complicated by acute pancreatitis due to splenic torsion. A 45-year-old multiparous woman with a history of psoriasis, gastro-esophageal reflux disease, and chronic pain presented with recurrent left upper quadrant abdominal pain and biochemical signs of pancreatitis. Cross-sectional imaging revealed splenomegaly, abnormal spleen positioning, and torsion of the splenic pedicle with a transient elevation in lipase. A multidisciplinary team diagnosed intermittent splenic torsion and detorsion complicated by traction on the pancreatic tail, leading to pancreatitis. Despite the recurrent nature of her symptoms, the patient remained clinically stable, allowing for elective robotic splenectomy. Intraoperatively, the spleen was found in the pelvis. Notably, the tail of the pancreas was also mobile and displaced from its normal location, necessitating a pancreatopexy to anchor and secure the body and tail of the pancreas within the left upper quadrant, thereby restoring normal anatomy and reducing the risk of future displacement. Wandering spleen can be a rare but important cause of recurrent abdominal pain and acute pancreatitis. Timely recognition of its imaging features and complications, such as splenic torsion and pancreatic inflammation, is essential. Elective splenectomy or splenopexy should be considered for patients with preserved splenic function and stable clinical status.

Peritoneal inclusion cysts (PICs) are benign, multilocular fluid-filled lesions that predominantly affect women of reproductive age, often arising after abdominal surgery or chronic inflammation. We report a case of a 28-year-old female presenting with chronic left upper-quadrant abdominal pain for 1 year. Radiological evaluation revealed a large cystic lesion closely abutting the left adrenal gland and adjacent organs, creating a diagnostic dilemma regarding its tissue of origin. The patient was planned for diagnostic laparoscopy, which revealed a large, thin-walled cyst containing clear serous fluid. The lesion was not arising from the suprarenal gland or the pancreatic tail. Complete excision of the cyst was performed, and histopathological examination confirmed the diagnosis of a PIC. Notably, the patient had no prior history of abdominal surgery, making this presentation particularly unusual. The postoperative course was uneventful, and at 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights a rare suprarenal presentation of a PIC in a "virgin" abdomen, closely mimicking adrenal and pancreatic cystic pathology on imaging despite normal endocrine evaluation. It underscores the importance of imaging - particularly ultrasonography and contrast-enhanced computed tomography of the abdomen and pelvis - in evaluating cystic lesions and differentiating PICs from Paraovarian cysts, hydrosalpinx, or ovarian malignancy based on anatomical location. However, due to significant imaging overlap with adrenal and pancreatic cystic lesions, histopathological confirmation remains essential. Diagnostic laparoscopy with complete excision was crucial in establishing the diagnosis, avoiding unnecessary adrenal resection, and ensuring a favorable outcome without early recurrence.

We present the case of a 67-year-old woman with a history of prior laparoscopic cholecystectomy who presented with right upper quadrant (RUQ) pain and nausea and was found to have recurrent acute cholecystitis. Review of the operative note from her previous cholecystectomy revealed that a rim of gallbladder tissue had been left behind due to anatomical complications. CT of the abdomen and pelvis demonstrated a distended gallbladder with cholelithiasis, wall thickening, and pericholecystic fluid, consistent with acute calculous cholecystitis despite her history of prior cholecystectomy. The patient was admitted and later underwent definitive laparoscopic total cholecystectomy. Intraoperatively, extensive RUQ adhesions were taken down, the cystic duct was identified and clipped, and the gallbladder remnant was excised. This case highlights the importance of considering gallbladder remnant acute cholecystitis in patients with prior subtotal cholecystectomy who present with RUQ pain.

Situs inversus totalis (SIT) is a rare genetic condition that presents a significant challenge for laparoscopic surgery because of its mirror-image anatomy. While reported globally, this is the first documented case of laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis in a patient with SIT in Ethiopia. A 43-year-old female with known SIT presented to the hospital with a 5-year history of dyspepsia and left upper quadrant abdominal pain. Ultrasound confirmed cholelithiasis. After a thorough preoperative workup to rule out associated syndromes, she underwent elective LC. A modified trocar placement and the "French" patient position were utilized to accommodate the anatomical reversal and facilitate the procedure for a right-handed surgical team. LC is a feasible and safe procedure for patients with SIT, even in settings where laparoscopy is emerging. The French position can simplify the procedure by minimizing the cognitive and technical load for the surgeon, avoiding the need for a complete mirror-image setup. This case underscores the potential for expanding advanced minimally invasive techniques in Ethiopia through collaborative education and training.

Spontaneous splenic rupture is a rare but potentially life-threatening condition. Although commonly associated with infections or malignancies, rupture of a normal spleen is extremely rare, and emergency surgery remains the usual management approach. We report a case of spontaneous rupture of a normal spleen successfully treated with elective laparoscopic splenectomy. A 47-year-old man presented with sudden-onset left upper-quadrant abdominal pain and dizziness. Imaging studies revealed splenic rupture without any evidence of trauma or underlying conditions. After initial non-operative management, laparoscopic splenectomy was performed due to the risk of rebleeding. Pathological examination of the excised spleen revealed no underlying cause, and the patient was diagnosed with spontaneous rupture of a normal spleen. A PubMed-based literature review identified only a few comparable cases over the past 5 years, most treated with emergency surgery. Our case indicates that non-operative management followed by elective surgery may be feasible in selected cases.

Splenic cystic lymphangioma is a rare, benign disease affecting the splenic lymphatic system; it is uncommon in adults and primarily seen in children. Symptoms are usually nonspecific. The diagnosis is confirmed by histopathological analysis. We report a 58-year-old female patient with left upper abdominal pain and a history of abdominal trauma with mild tenderness over the left upper quadrant. Abdominal ultrasound revealed a well-defined multilocular cystic lesion in the spleen, measuring ~7.9 × 6.9 cm. Then, abdominal and pelvic computed tomography revealed a large, non-enhancing hypodense cystic lesion in the spleen with internal septations, calcifications, and multiple smaller daughter cysts arranged peripherally; hydatid cyst was the primary differential diagnosis. After that, she underwent an open splenectomy under general anesthesia. Final pathology results confirming a benign splenic cystic lymphangioma. Splenic cystic lymphangiomas are rare, non-malignant tumors that are infrequently diagnosed in adults. Surgical removal via splenectomy is the treatment of choice.

Situs inversus totalis is a rare congenital condition that can complicate the diagnosis and management of acute abdominal pathology due to atypical symptom localization. Acute cholecystitis in this setting may present with left-sided abdominal pain, increasing the risk of misdiagnosis and delayed treatment. The scientific rationale for this case report is to emphasize the importance of recognizing anatomical variants when evaluating atypical abdominal presentations. We report the case of a 65-year-old woman who presented with left upper quadrant pain, nausea, and vomiting. Imaging studies demonstrated dextrocardia and complete mirror-image transposition of the thoracic and abdominal organs, consistent with situs inversus totalis, along with findings of acute calculous cholecystitis. The patient underwent laparoscopic cholecystectomy using a mirrored port placement technique without complications and had an uneventful recovery. This case highlights that early use of imaging and appropriate surgical adaptation enable safe laparoscopic management. Future research should focus on multicenter data to better characterize diagnostic delays and refine surgical strategies in patients with situs inversus totalis.