Ascites management is currently guided by well-established surgical principles, including careful patient selection, controlled fluid removal, and prevention of circulatory dysfunction during paracentesis. Although framed in modern physiological terms, these principles have conceptual roots in earlier medical traditions. This study re-examines the surgical management of ascites within the medieval Islamicate medical tradition, encompassing medical cultures and scholarly practices that developed in societies shaped by Islamic civilization, rather than referring solely to religious doctrines or institutions. The study focuses on operative reasoning rather than historical description. Primary sources, including Avicenna's Canon of Medicine, Rhazes' Al-Hawi, Haly Abbas' Kamil al-Sina'ah, and Albucasis' Al-Tasrif, were analyzed thematically to identify underlying surgical principles. These findings were contextualized in relation to earlier Greco-Roman writings, particularly those of Paul of Aegina, and compared with contemporary clinical concepts in ascites management. The analysis demonstrates that medieval Islamicate physicians developed a coherent framework for ascites intervention based on 4 core principles: (1) strict patient selection prior to surgery, (2) gradual and controlled fluid evacuation, (3) recognition of physiological tolerance and operative risk, and (4) structured postoperative care. Despite differences in theoretical background, these principles closely parallel modern concepts in large-volume paracentesis, including prevention of paracentesis-induced circulatory dysfunction and risk stratification before intervention. Rather than constituting isolated historical techniques, these writings reflect an early form of physiology-guided surgical judgment. This reframing highlights the continuity of operative principles across medical history and underscores the relevance of classical Islamic medical literature to contemporary surgical decision-making.

Inflammatory root resorption (IRR) frequently causes hard-tissue defects within the root canal system. The present report describes two cases in which regenerative endodontic treatment (RET) was used to manage premolars complicated by severe IRR, apical root segment separation and extensive periapical lesions. The first case involved an 11-year-old male patient with a fractured premolar (tooth 20) that exhibited IRR-induced apical segment separation. Case 2 involved a 15-year-old male patient presenting with severe IRR in tooth 20, characterized by an open, anomalous apical foramen and a large periapical lesion. Both teeth were managed by RET. In case 1, a regenerative scaffold was created by inducing periapical bleeding. In case 2, due to inadequate periapical bleeding, an alveolar-derived autologous blood clot obtained via aspiration from the maxillary terminal alveolar bone was utilized as the scaffold. Clinical and radiographic outcomes were documented over 2- and 3-year follow-up periods, respectively. At the 2-year follow-up in case 1, the tooth exhibited complete resolution of clinical symptoms, healing of the periapical lesion and arrest of IRR. Radiographic assessment revealed re-approximation of the apical root segment separated from the main root canal. However, the newly mineralized tissue deposition was insufficient to fully restore root continuity. At the 3-year follow-up in case 2, the patient remained asymptomatic, with complete healing of the periapical lesion and arrested IRR. These two cases suggest that RET may be beneficial for severe IRR complicated by apical root segment separation and large periapical lesions; however, further clinical studies are warranted to confirm these findings.

Spontaneous bacterial peritonitis (SBP) is classically associated with liver cirrhosis and portal hypertension. Its occurrence in non-cirrhotic patients is rare and poorly characterized. Pancreatic ascites, resulting from disruption of the pancreatic duct (PD) or leakage from a pseudocyst, is an unusual cause of ascites in chronic pancreatitis. The enzyme-rich, exudative nature of this fluid can itself cause chemical peritonitis with neutrophilia, mimicking infection. We report the case of a 50-year-old man with alcohol use disorder and chronic calcific pancreatitis who presented with recurrent massive ascites in the absence of hepatic cirrhosis. Paracentesis revealed a markedly elevated ascitic fluid amylase level (14,619 U/L) and a polymorphonuclear leukocyte (PMN) count exceeding 250 cells/mm[3]; the ascitic fluid culture was negative. Given the negative culture, we classified the condition as culture-negative neutrocytic ascites (CNNA), with a clinical syndrome highly consistent with SBP, rather than as culture-confirmed SBP. The serum-ascites albumin gradient (SAAG) was 1.5 g/dL, supporting the presence of portal hypertension, which was attributed to nonocclusive portal vein thrombosis (PVT). Imaging identified a PD stricture with upstream dilatation and a leak tracking into the peritoneal cavity. Endoscopic retrograde cholangiopancreatography (ERCP), attempted for therapeutic PD drainage, was unsuccessful because of pancreatic calcifications and distorted ductal anatomy. The admission was further complicated by acute aortoiliac thromboembolism, compartment syndrome, and chylous ascites, all of which were successfully managed with surgical and supportive care. Conservative management with intravenous antibiotics, total parenteral nutrition (TPN), a low-fat diet, and octreotide led to spontaneous resolution of the PD leak, as confirmed by secretin-enhanced magnetic resonance cholangiopancreatography (MRCP). Neutrocytic ascites clinically consistent with SBP may occur in non-cirrhotic patients when a PD leak and localized portal hypertension coexist. However, the anatomical connection between the PD and the gastrointestinal lumen, together with the limited sensitivity of cultures in this setting, means that such cases may be more accurately classified as CNNA. Clinicians should maintain a high index of suspicion for infectious peritoneal complications in patients with pancreatic ascites while using precise terminology that reflects genuine diagnostic uncertainty.

A boy in late adolescence presented with fever, weight loss, mediastinal and retroperitoneal lymphadenopathy, and was diagnosed with extrapulmonary tuberculosis. His clinical course was complicated by drug-induced liver injury, a tubercular psoas abscess requiring percutaneous drainage. After this procedure he developed rapidly recurring chylous ascites requiring frequent large-volume paracentesis. Despite prolonged antitubercular therapy, ascites persisted. Magnetic resonance lymphangiography demonstrated leakage from retroperitoneal lymphatics into the right perinephric region together with non-opacification of the thoracic duct beyond the cisterna chyli, suggesting lymphatic obstruction secondary to healed tuberculous lymphadenitis. Conservative measures, including dietary modification and octreotide, were unsuccessful. The patient underwent intranodal lymphatic embolisation using a glue-lipiodol mixture, resulting in sustained resolution of ascites. This case highlights the complex lymphatic complications of tuberculosis and demonstrates the diagnostic and therapeutic value of advanced lymphatic imaging and embolisation in refractory chylous ascites.

BACKGROUND Image-guided pericardiocentesis is a diagnostic and potentially life-saving intervention, yet even under guidance, rare complications can occur. Among them, bowel perforation with subsequent fecal pericarditis is an exceptionally uncommon and often under-recognized occurrence. CASE REPORT We describe the case of a 72-year-old man with multiple comorbidities, including acute colonic pseudo-obstruction (Ogilvie syndrome), Parkinson disease, and chronic kidney disease, who underwent urgent fluoroscopy-guided pericardiocentesis for a large pericardial effusion. After the procedure, his drain ceased to release any fluid, and he experienced progressive tachycardia. Imaging revealed that the catheter inadvertently penetrated the transverse colon, resulting in pneumoperitoneum and pneumopericardium. He required combined thoracic and abdominal surgery, including a pericardial window, controlled drain removal, primary colonic repair, and diverting colostomy. His recovery was uneventful, and he was discharged in stable condition. CONCLUSIONS Only a handful of similar cases are reported in the literature. Our case presents additional evidence that image-guided pericardiocentesis may be associated with an increased risk of iatrogenic bowel injury in patients with abdominal distension or colonic dysmotility. The patient was treated surgically for pericardial drainage and repair of colonic perforation, further addressing the patient's dysmotility at the time of surgery with the creation of a diverting colostomy. Awareness of unusual drain behavior and early imaging can expedite recognition and management of this life-threatening complication.

Ascites is a rare presentation of hypothyroidism and can be easily mistaken for malignancy when it occurs alongside pleural effusion and radiological lymphadenopathy. We report the case of a 63-year-old man who presented with progressive generalized anasarca, abdominal distension, and worsening breathlessness. Diagnostic paracentesis revealed exudative ascites with a low serum-ascites albumin gradient (SAAG) and markedly elevated protein content, and thyroid function testing showed profound, previously undiagnosed primary hypothyroidism (thyroid-stimulating hormone (TSH) 221.2 µIU/mL). On a subsequent admission, contrast-enhanced CT additionally revealed bilateral pleural effusion with mediastinal lymphadenopathy and omental fat stranding, raising concern for an underlying malignant or granulomatous process. Repeat ascitic fluid analysis, cytology, tumor markers, and cartridge-based nucleic acid amplification test (CBNAAT) were unremarkable, and an omental biopsy was performed and was not suggestive of inflammatory pathology; in view of this reassuring result, together with the patient's frailty and early clinical improvement, the higher-risk procedure, mediastinal lymph node biopsy, was deferred by multidisciplinary consensus in favor of a trial of thyroid hormone replacement. This strategy proved correct: with initiation and titration of levothyroxine, the patient's ascites, pleural effusion, and edema resolved completely on serial follow-up, obviating the need for mediastinal lymph node sampling. This case illustrates that myxedema ascites can radiologically mimic malignancy and that thyroid function testing, together with judicious, risk-stratified tissue sampling and, where clinically appropriate, a closely monitored trial of thyroid hormone replacement, can help a frail older adult avoid an unnecessary high-risk biopsy.

A 7-year, 6-month-old, female neutered, Pug dog presented with lethargy, hyporexia, polydipsia, abdominal distension, and dyspnea. Point-of-care ultrasonography identified tricavitary effusions and cardiac tamponade. Pericardiocentesis yielded 83 mL of sanguineous scintillating fluid. Clinical examination, bloodwork, echocardiography, electrocardiography, thoracic and abdominal computed tomography scans, and pericardial fluid analysis including culture and sensitivity did not identify any cardiovascular, endocrine, neoplastic, or infectious causes of the pericardial effusion. Pericardial fluid analysis identified high cholesterol concentrations and numerous cholesterol crystals on cytology, supporting a diagnosis of cholesterol pericarditis. Subtotal pericardiectomy was performed 7 weeks later to address pericardial and pleural effusions. Histopathological pericardial biopsies identified pericarditis with no neoplastic tissue detected. A pleural port was placed 4 months later to manage recurrent pleural effusion. Elective euthanasia was performed 10 weeks later citing a compromised quality of life from increasingly frequent bouts of dyspnea. This is a case report of a dog with idiopathic cholesterol pericarditis presenting with cardiac tamponade.