Intrapancreatic accessory spleens are common asymptomatic masses that generally cause no problems. Usually, they are incidentally found on imaging as a pancreatic mass and they pose a diagnostic and management dilemma due to equivocal imaging findings. Evolving imaging modalities and increasing use of endoscopic ultrasound with fine needle aspirate may result in the avoidance of unnecessary operations and surveillance. We report a case of distal pancreatectomy and splenectomy for a pancreatic tail solid lesion.

No abstract

Fig. 3. Haematoxylin and eosin micrograph showing splenosis with architecture identical to normal splenic tissue.2Images for surgeons

Obturator hernia (OH) is a rare type of pelvic hernia. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25–100%). We present an 88-year-old woman who presented with symptoms of bowel obstruction and right hip pain. Computed tomography (CT) abdomen revealed bilateral OHs and bowel obstruction secondary to the right OH. She was managed conservatively due to her age and co-morbidities and her bowel obstruction subsequently resolved. She was discharged, only to re-present 1 month later with similar complaints. A repeat CT scan revealed bilateral OHs and bowel obstruction due to the left OH. She underwent midline laparatomy and both OHs were reduced. The right OH was fixed with polypropylene mesh plug and the left OH was fixed with primary closure. The patient recovered and no recurrence was noted during follow-up.