Spontaneous total regression of post-acute pancreatitis splenic artery pseudoaneurysm: A case report and review of the literature.

INTRODUCTION: Splenic artery pseudoaneurysms (SAP) are uncommon but significant vascular complications frequently associated with pancreatitis. These lesions carry a substantial risk of rupture and subsequent life-threatening hemorrhage. Standard treatment typically involves surgical or endovascular intervention to prevent such catastrophic outcomes. However, this case report documents a rare instance of spontaneous regression of a SAP following severe pancreatitis, challenging the established treatment protocols and highlighting the potential for conservative management under specific conditions. CASE PRESENTATION: A 65-year-old male with a past history of acute biliary pancreatitis secondary to gallstones, which was treated with laparoscopic cholecystectomy, presented with severe abdominal pain and a significant drop in hemoglobin levels. Imaging revealed acute pancreatitis with multiple pseudocysts and a newly identified 10 mm splenic artery pseudoaneurysm exhibiting recent bleeding. Although arterial embolization was recommended, the patient opted for non-invasive management. Intensive monitoring and conservative treatment were initiated. Over several days, his symptoms improved, and follow-up imaging showed spontaneous thrombosis of the SAP. One month later, a CT scan confirmed the complete resolution of the pseudoaneurysm. DISCUSSION: SAPs are serious complications of pancreatitis, often necessitating urgent intervention due to high rupture risk. This case of spontaneous regression underscores the importance of individualized management strategies. It suggests that conservative treatment may be a viable option for stable patients with resolving pancreatitis, although such cases are rare and require careful monitoring. CONCLUSION: While the primary approach to managing SAP remains interventional due to the high risk of rupture, this case highlights the potential for spontaneous regression in select circumstances. It underscores the need for personalized treatment plans.

Cholecystitis in a midline gallbladder: A rare ectopic location.

INTRODUCTION: The ectopic gallbladder is an uncommonly encountered anomaly that surgeons should be aware of. Its diagnosis is difficult but can be elucidated with the use of computed tomography and MRCP. PRESENTATION OF CASE: We present a case of a 64-year-old patient who presented with abdominal pain, inflammatory epigastric mass and fever. Computed tomography (CT) revealed the presence of a para-umbilical gallbladder with signs of acute cholecystitis. Laparoscopic exploration revealed that the gall bladder was not present in its usual fossa but was seen attached to the midline anterior abdominal wall with extensive adhesion between it and the omentum. Given the complexity of the cholecystectomy via the laparoscopic approach, a conversion to a midline incision was performed. The IOC confirmed the absence of anatomical variants of the biliary tree. DISCUSSION: An ectopic gallbladder is a difficult entity to diagnose as it can create clinical confusion by tampering with the common clinical presentation of cholecystitis. MRCP is currently one of the most effective preoperative examination methods as it detects the coexistence of biliary tract variation. Laparoscopic surgery is a safe procedure to be performed in the ectopic gallbladder. CONCLUSION: Ectopy of the gallbladder is a rare congenital abnormality that should be kept in mind to avoid errors or delays in management.

Hydatid cyst of the liver fistulized into the inferior vena cava.

INTRODUCTION: Fistulization or rupture of hydatid liver cysts to the inferior vena cava (IVC) is an extremely rare and life-threatening condition. PRESENTATION OF CASE: We report the case of a 70-year-old patient who presented with right-upper-quadrant pain and fullness evolving for 03 months. Physical examination showed dilated veins over the anterior abdominal wall and the flanks associated with lower-extremity swelling. Computed tomograph of the abdomen showed a hydatid cyst invading segments VI and VII of the liver fistulized into the inferior vena cava. The IVC was partially trombosed. The diagnosis of a possibly ruptured hydatid cyst in the inferior vena cava was then made. The patient underwent surgical management. Per-operatively the cystic cavity had bloody content but the cysto-vascular communication was not identified. Partial cystectomy was performed leaving a fairly extensive contact between the calcified pericyst and the IVC. The postoperative course was uneventful. DISCUSSION: Rupture of the hepatic hydatid cyst into the IVC is very rare and may lead to fatal pulmonary embolism secondary to the migration of vesicles in the pulmonary artery or haemorrhagic shock. CT scan remains the best investigation method to assess the vascular links of the hepatic hydatid cyst especially with the IVC. Surgical treatment of the hepatic hydatid cyst ruptured into the IVC mandates vascular control before the hydatid cyst is punctured or removed. CONCLUSION: Fistulized hydatid cysts into the IVC should be operated on in centres equipped for extracorporeal bypass techniques, and experienced in the surgery of hepatic echinococcosis.