A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration.

Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12-72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

Ultrashort-segment Hirschsprung disease in a 4-year-old female.

Hirschsprung disease (HSCR) is characterized by the absence of neuronal ganglion cells in a distal portion of the intestinal tract [1]. In 1691, Frederick Ruysch described the disease as congenital megacolon. HSCR-associated congenital anomalies have been reported in 5-32% of affected patients [2]. The clinical symptoms of HSCR are usually evident in the neonatal period. However, in some cases where the extent of the aganglionic segment is short, symptoms may become clinically relevant later in childhood [3]. HSCR is one of the most difficult diseases to identify in pediatric surgery due to its multiple clinical, histological and radiological variations [2, 3]. The goal of surgical management is to remove the aganglionic segment and reconstruct the intestinal tract through techniques such as Swenson, Duhamel and Soave [4]. The following case consists of a 4-year-old patient with a chronic presentation of constipation secondary to ultrashort-segment Hirschsprung disease.

Nontraumatic chylothorax secondary to lymphoma and filariasis.

Chylothorax is characterized by extravasation of chyle into the pleural space resulting from thoracic duct damage. The effusion is most commonly unilateral, with the right and left side being affected in 50% and 33.3% of the patients, respectively. Only 16.66% of cases present a bilateral effusion. The underlying etiology can be classified as spontaneous or traumatic. The diagnosis is made through pleural fluid analysis and imaging studies. The following article presents two cases of left spontaneous chylothorax: a 26-year-old male presenting with a chylous pleural effusion due to a non-Hodgkin lymphoma and a 47-year-old patient from a tropical area with a chylous pleural effusion attributed to filariasis. Filariasis as a cause of chylothorax is uncommon and there is not much literature on the topic. Alongside the case presentations, information on chylothorax etiology, mechanism, diagnosis and treatment options is provided.