Intestinal torsion causing chylous ascites: a rare occurrence

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.

new chemoimmunotherapy regimen [OXAFI] for advanced hepatocellular carcinoma

Chemotherapeutic treatment options for advanced unresectable and/or metastatic hepatocellular carcinoma [HCC] are limited. Currently available treatments are associated with low response rates and little evidence of improved survival, so we evaluated a new chemoimmunotherapy regimen. Seven patients with unresectable and/or metastatic HCC were treated with intravenous oxaliplatin [30mg/m[2]] and doxorubicin [20mg/m[2]] given on days 1, 8 and 15 in a 28-day cycle, a daily continuous infusion of fluorouracil [200mg/m[2]] and subcutaneous interferon alfa-2b 5 MU administered thrice weekly [OXAFI]. Treatment was administered to a maximum of six cycles. Data on the response to treatment, toxicity, surgical procedures and survival outcome was reviewed. The best response was three partial responses, three stable disease responses and one progressive disease response. Two patients underwent interval hepatic resection, and histological analysis in one patient showed a complete pathological response. Another patient underwent a liver transplant after four cycles of treatment. These three patients were alive with no evidence of disease at 23, 21 and 18 months follow-up, respectively. At a median follow-up of 14 months [range 2-23 months], one patient died 2 months after diagnosis due to progressive disease, while all six other patients were alive. Neutropenia was the predominant toxicity, but there were no episodes of febrile neutropenia, hospital admissions or deaths. There were no cases of hepatitis B virus re-activation. OXAFI shows activity in HCC and has manageable toxicity. Complete pathological remission is possible with this regimen