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C a s e R e p o r t e88 INTRODUCTIONSince the first case of acute chylous peritonitis described by Renner (1) CASE REPORTA Computed tomography (CT) showed a whirl-like appearance, with a collapsed bowel around the superior mesenteric artery (Fig. 1). There was also an abrupt cut-off of the superior mesenteric vein just distal to the splenoportal confluence (Fig. 2). This was suggestive of intestinal torsion.On exploratory laparotomy, two litres of chylous fluid was drained from the peritoneal cavity. The small bowel mesentery was torted around an adhesion band between the transverse colon and duodenum. The small bowel mesentery was found to be long and narrow, and the position of the caecum was to the right and more cranial than usual. The bowel was well-perfused, pink and only mildly dilated. Superior mesenteric arterial pulsations were prominent.The bowel was detorted in a counterclockwise manner and the coloduodenal adhesion band was taken down. AdhesionsIntestinal torsion causing chylous ascites: a rare occurrence ABSTRACT Intestinal torsion and chylous ascites are very rarely associated. We present the case of a 19-year-old man who presented with acute abdomen. Computed tomography of his abdomen showed features suggestive of intestinal torsion. Chylous ascites was incidentally discovered on exploratory laparotomy. The chylous fluid was drained, the small bowel detorted and the coloduodenal adhesion band taken down. The patient's retroperitoneum was explored to exclude occult masses and malformations of the lymphatics. Post surgery, the patient recovered uneventfully. In this case, we postulate that intestinal malrotation had caused the obstruction of the lymphatic flow from the mesenteric lymphatic channels, leading to the exudation of chyle, which then resulted in the accumulation of chylous fluid in the peritoneal cavity. It is important to exclude the more common causes of atraumatic chylous ascites, such as enlarged retroperitoneal lymph nodes or lymphatic malformations.

HighlightsAnterior tibial artery (ATA) pseudo aneurysm is rare after total knee arthroplasty.Pseudo aneurysms can be asymptomatic or present with nerve palsy or rupture.Diagnosis can be made with noninvasive imaging or digital subtraction angiography.Ligation of the ATA and excision of its aneurysm is a safe and durable solution.

INTRODUCTIONRenal squamous cell carcinoma (RSCC) is a rare tumor that is usually diagnosed late as a locally advanced malignancy with adjacent structure involvement. Radical surgical resection with negative margins is the mainstay of treatment, as it is correlated with improved survival, while other modalities of treatment have been shown to have limited efficacy.PRESENTATION OF CASEWe report a case of a 56 year old gentleman with right RSCC with tumor encasing the inferior vena cava (IVC), treated successfully with surgical resection.DISCUSSIONThe surgical management of vascular involvement of similar tumors has not been discussed in-depth in the literature. Surgical resection of the IVC without reconstruction can be done successfully in the circumstance of good collateral circulation; otherwise IVC resection with reconstruction will be necessary.CONCLUSIONRadical resection with clear margins of RSCC tumors with vascular involvement is feasible in selected circumstances.

Foreign bodies causing perforation of hernias are extremely uncommon with only a few cases reported in the literature. Here, we present a case of a patient with ingestion of a foreign body, which was initially managed expectantly but developed a perforation due to the foreign body impacting and causing perforation of an irreducible inguinal hernia. Management of this condition usually involves resection of the involved loop of bowel with repair of the hernia defect at the time of surgery. Patients with ingested foreign bodies who have irreducible hernias have altered anatomy and should be considered for early surgical intervention to prevent complications.