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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.

Liver cirrhosis with splenomegaly and portal hypertension has been described in the medical literature as increasing the risk of splenic rupture. We report a case of atraumatic splenic rupture in a male with liver cirrhosis associated with splenomegaly, which was further complicated by hypersplenism and intra-cystic haemorrhage in the spleen. The 56-year-old man was hospitalized because of sudden onset of intermittent pain in the left quadrant abdomen with no history of trauma. Upon admission, the patient presented no fever, palpable abdominal tenderness, splenomegaly, and hypersplenism. Enhanced computed tomography revealed a splenic subcapsular haematoma connected to a cystic mass located at the splenic hilum and free fluid in the abdomen, which is indicative of splenic rupture. The patient underwent immediate laparotomy and splenectomy followed by proper management. Post-surgery diagnostic microscopy indicated liver steatosis, perivenular fibrosis, and regenerative nodules, which are suggestive of cirrhosis. The patient was discharged from the hospital with an uneventful recovery.