Abscess of the ligamentum teres hepatis has been described in the medical literature as an extremely rare clinical entity, which often presents a diagnostic dilemma. A 68-year-old man was hospitalized for upper abdominal pain and obstructive jaundice. The patient presented with low-grade intermittent fever. Laboratory investigations showed a white blood cell count of 32.38 × 109/L, a C-reactive protein level of 247.86 mg/L, abnormal liver enzyme and bilirubin levels, and elevated serum levels of amylase and lipase. He was first diagnosed with acute biliary pancreatitis. A computational tomography scan and magnetic resonance cholangiopancreatography revealed obstructive choledocholithiasis and cholecystolithiasis. The patient received preoperative antibiotics and symptomatic treatments for 5 days, followed by endoscopic retrograde cholangiopancreatography and a subsequent duodenal papilla incision to extract pigment and cholesterol gallstones. The patient recovered and was discharged on the fifth day after surgery. However, 10 days later, the patient was readmitted for the recurrence of acute calculous cholecystitis. Laboratory tests showed increases in total and direct bilirubin, γ-glutamyltransferase, and alkaline phosphatase, but not inflammatory parameters. After the patient’s nutritional status improved on the 11th day after admission, a laparoscopic cholecystectomy was performed. Intraoperative exploration revealed extensive abdominal adhesions; a thickened edematous gallbladder wall; and an unexpected abscess of the ligamentum teres hepatis. Pus aspiration was performed laparoscopically after laparoscopic cholecystectomy, and to ensure elimination of the abscess, ultrasound-guided pus aspiration was also performed 1 week later. Fortunately, the patient made an uneventful recovery and was discharged with a drain tube on the 16th day after surgery. Doppler ultrasound indicated that the abscess had completely disappeared 2 weeks after discharge. This case highlights an unusual presentation of a ligamentum teres hepatis abscess caused by obstructive cholangitis but that appeared after the choledocholithiasis was resolved. However, the mechanism of abscess formation remained uncertain.

Afferent loop (A-loop) obstruction presenting as acute pancreatitis is a rare clinical entity. We report a case of A-loop obstruction that occurred 15 years after Billroth II gastrectomy, leading to acute pancreatitis and accompanied by duodenal perforation and peritonitis. A 63-year-old man complaining of upper abdominal pain, distention, and nausea was referred to our hospital. The patient was previously treated with antibiotics and gastrointestinal decompression at the primary healthcare institute after being diagnosed with acute pancreatitis. However, the symptoms did not improve. Upon inter-hospital transportation, he experienced a period of relief from the pain but soon developed signs of diffuse peritonitis. Laboratory examination showed elevated serum amylase and lipase. A computed tomography scan revealed slight edema of the pancreas, a dilated and fluid-filled bowel loop across the mid-abdomen, and fluid accumulation in the abdominal cavity and pelvis. An emergency laparotomy was conducted, followed by symptomatic treatments. The patient had an uneventful recovery and was discharged in 4 weeks.