BackgroundChylous ascites is considered to be an intra-abdominal collection of creamy colored fluid with triglyceride content of > 110 mg/dL. Chylous ascites is an uncommon but serious complication of numerous surgical interventions. However, it is a rare complication of LRYGB. An internal hernia limb defect is thought to be the underlying etiology, where the hernia will cause lymphatic vessel engorgement and lymphatic extravasation.Case presentationWe report a case of a 29 years old male with a 9 year history of laparoscopic Roux en y gastric bypass (LRGYB), presenting with recurrent abdominal pain for 2 months radiating to the right shoulder. Ultrasound examination revealed gallstones and the patient was subsequently admitted for laparoscopic cholecystectomy. Intraoperatively, whitish colored fluid, high in triglycerides content was aspirated. During exploration, an internal hernia limb defect was found and corrected.ConclusionPost LRGYB patients with symptoms of recurrent abdominal pain should be suspected for chylous ascites reflecting an internal hernia.

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Background: Surgical site infections (SSI) continue to be one of the most common post-operative consequences following surgery, it is an infection that develops in the incision made during a surgical operation is a significant cause of hospital morbidity, increasing ICU admission rates, hospital readmission, lengthening total hospital stay and tripling death rates. To assess knowledge and awareness about wound infection after surgery among population in Saudi Arabia. Materials and Methods: A cross-sectional study was conduct in Saudi Arabia during July to December 2021, we distributed our questionnaire in Kingdome of Saudi Arabia, the participants involving general population adult living in Saudi (>15). The sample size was 3357 participants. The sample size was estimated using the Qualtrics calculator with a confidence level of 95%. Our inclusion criteria were Age,15 years old and older, residency in Saudi Arabia, Male and female, Saudi and non-Saudi, agree to participate. Analyzes was done by using the “Microsoft Office Excel Software” (2019) for Windows was used to enter data on the computer. The data was then statistically evaluated using the SPSS program, version 23. Results: 63.8% of the participants were females. More than half of the respondents were younger than 25 years old. Most of the respondents (9.1%) had a university degree or higher education. Regards area of residence, 10.1% lived in Riyadh, 14.0% in Medina. The prevalence of SSI was 8.0%. There are 50.2% of respondents have reported that times being admitted to hospital were 5 or less, 53.9% have denied history of undergoing other previous surgeries. Also, 95.5% of respondents denied having a hospital acquired infection besides surgical site infection. Conclusion: SSI is one of the commonest healthcare related infections which have a great impact on patient morbidity and mortality. The causes of SSIs are multi-factorial. The antimicrobial regimen isn’t much more effective than the persuasive strategy in controlling antimicrobial use in the long-term. Moreover, in many settings, there may be inadequate personnel for a restrictive approach and restriction strategies are unable to consider the appropriateness of use of non-restricted antibiotics, which forms the vast majority of antibiotics used in hospital.

Background Isolated iliac artery aneurysms are rare and difficult to diagnose. It is more common in males. It can be asymptomatic at diagnosis or can present with frank rupture, or symptoms caused by compression on nearby organs. Case presentation A 44 years old male was diagnosed with rectosigmoid adenocarcinoma and underwent low anterior resection. One year after the surgery, he presented with fistula between the rectal stump and left iliac artery that was managed by stenting. Conclusion A fistula between the rectal stump and the left iliac artery is very rare. There are several treatment options for ilio-rectal fistula but no conclusive specific treatment.