Ileosigmoid knot is rare yet life-threatening condition caused by acute double loop intestinal obstruction. Preoperative diagnosis is difficult and it is associated with high morbidity and mortality. We present one such patient we encountered and outline our management, and discuss the surgical options available.

Primary malignant pericardial mesothelioma is extremely rare, with a reported prevalence of 0.0022% at autopsy series. It is, however, the most common primary malignancy of the pericardium. To date, only few hundred cases have been reported in the literature. Unlike peritoneal and pleural mesothelioma, there has been no definite correlation between asbestos exposure and pericardial disease. Malignant pericardial mesothelioma carries a poor prognosis with no successful treatment strategies and little benefit from radiation and chemotherapy. We report a 28 year-old man with no medical history who presented with two weeks of worsening dyspnea on exertion to minimal efforts and severe orthopnea. We discuss the diagnostic approach and therapy in our patient and provide a review of the literature pertaining to the epidemiology, clinical features of pericardial mesothelioma and its diagnosis and treatment.Key-words: Cardiac neoplasm; Pericardium; Mesothelioma; Constrictive pericarditis; Key Message: Malignant mesothelioma of the pericardium is a very rare neoplasm. Clinical presentation is insidious and invariably followed by progression to tamponade, heart failure or pericardial constriction. Cross sectional imaging followed by biopsy are necessary for a conclusive diagnosis. Successful treatment strategies for this malignancy are lacking so prognosis remains poor.