Splenic artery aneurysm (SAA) rupture is a rare but life-threatening cause of acute abdominal pain, with mortality exceeding 25% in undiagnosed cases. This report describes a giant SAA rupture that was initially misdiagnosed as a pancreatic pseudocyst on non-contrast computed tomography (CT), highlighting a critical diagnostic pitfall. A 49-year-old hypertensive male presented with sudden-onset left upper quadrant pain and nausea. Initial non-contrast CT showed cystic lesions with peripheral calcification, which were radiologically interpreted as a pancreatic pseudocyst. The patient subsequently developed hemodynamic collapse due to a "double rupture" phenomenon. Emergency CT angiography revealed a ruptured giant SAA (5.2 cm). Emergency laparotomy and splenectomy were performed successfully. This case illustrates the limitations of non-contrast CT in differentiating SAAs from cystic pancreatic lesions and reinforces the necessity of a low threshold for CT angiography in unexplained upper abdominal pain.

Hepatic artery pseudoaneurysm is a rare but potentially life-threatening vascular condition, with risks of rupture, fistula formation, and massive hemorrhage. It most commonly occurs secondary to trauma, infection, inflammation, or iatrogenic injury. In this report, the case of a 15-year-old boy with idiopathic juvenile arthritis who presented with chronic anemia, intermittent right upper quadrant and epigastric pain, low-grade fever, and occasional vomiting for two years is reported, with repetitive attacks of pancreatitis. Ultrasound of the abdomen showed sludge in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) showed the lumen of the gallbladder with an ill-defined fluid level suggestive of a sludge ball, and a wall thickness of 3 mm. So, a laparoscopic cholecystectomy was performed on the basis of the patient's symptoms and findings. Postoperatively, after one month, the patient had symptoms of abdominal pain, melena, and a fall in hemoglobin. CT scan and selective angiography revealed a small pseudoaneurysm arising from the medial branch of the left hepatic artery with associated biliary duct dilatation, suggestive of an arteriobiliary fistula. The patient underwent transcatheter coil embolization. Post-embolization angiography confirmed complete occlusion of the pseudoaneurysm with preserved hepatic arterial flow. Early recognition and timely endovascular intervention are essential to prevent life-threatening complications, including rupture and massive hemorrhage.

Infectious mononucleosis, caused by Epstein-Barr virus (EBV), is a common illness in adolescents and young adults that usually follows a benign, self-limiting course. We report the case of an otherwise healthy 18-year-old woman who developed a radiologically confirmed splenic infarct presenting with left upper quadrant abdominal pain as a rare complication of infectious mononucleosis. Imaging demonstrated splenomegaly with a subcapsular wedge-shaped splenic infarct. She was managed conservatively with analgesia, observation, activity restriction, and interval imaging, with complete radiological and clinical resolution. This case highlights splenic infarction as a rare but likely under-recognised complication of EBV infection that can mimic more common abdominal pathology. Clinicians should maintain a high index of suspicion for splenic complications in patients with infectious mononucleosis who develop new or focal left upper quadrant abdominal pain, as prompt diagnosis facilitates appropriate management.

Traumatic diaphragmatic hernia (TDH) is an uncommon condition resulting from blunt or penetrating thoracoabdominal trauma and is frequently underdiagnosed due to its nonspecific presentation. Delayed diagnosis may occur months or even years after the initial injury, increasing the risk of serious complications. Left-sided involvement is more common, and defects typically occur in areas of embryologic weakness. The persistent pressure gradient between the abdominal and thoracic cavities promotes progressive herniation of abdominal viscera. The stomach is commonly involved, and its displacement into the thoracic cavity may predispose to gastric volvulus. This can compromise vascular perfusion, leading to ischemia, necrosis, and perforation. We report the case of a 25-year-old male with a history of penetrating thoracoabdominal trauma due to a stab wound to the left hemithorax four years prior to presentation. He was admitted with a four-day history of progressive left upper quadrant abdominal pain associated with nausea. Imaging studies revealed a left-sided diaphragmatic hernia with intrathoracic herniation of the stomach, complicated by gastric volvulus and ischemia. Contrast-enhanced computed tomography was essential for diagnosis, allowing precise identification of the diaphragmatic defect, herniated viscera, and associated complications, thereby guiding surgical management. The patient underwent surgical intervention with reduction of herniated contents, partial gastrectomy due to extensive necrosis, and primary repair of the diaphragmatic defect. This case underscores the potential for rapid progression to life-threatening complications, including gastric necrosis, in delayed TDH. Early recognition and prompt surgical intervention remain critical to improving outcomes.

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.