1. Fifty-nine patients with various inter-carpal dislocations have been reviewed. 2. In this series trans-scapho-perilunar fracture-dislocation was the commonest injury. Early cases can be reduced by closed manipulation but in late cases operative reduction is usually advisable. When the injury is more than three months old, arthrodesis of the wrist joint is indicated. 3. When trans-scapho-perilunar fracture-dislocation was complicated by avascular necrosis of the proximal scaphoid fragment, the results in a small series treated by early excision were approximately equal to those treated by continued immobilisation. The results of grafting the scaphoid were poor. 4. Dislocations of the lunate seen within ten days of injury could usually be reduced with good results; no such case developed Kienböck's disease within the period of review. In late cases excision gave satisfactory results. 5. Forward dislocation of the lunate with half the scaphoid gave good results when manual reduction succeeded, but the results of excision of fragments were less satisfactory. 6. There was one case of forward dislocation of the lunate together with the distal half of the scaphoid. 7. Subluxation of the scaphoid is disclose in antero-posterior radiographs by a typical gap between it and the lunate bone. The subluxation may become recurrent and present a characteristic syndrome. 8. Other rare dislocations of the carpal bones are described.

A 45-year-old woman previously fit and well, developed a pseudoaneurysm of the breast following core needle biopsy. She was ultimately reassured and discharged without further intervention. Pseudoaneurysm is a rare complication of core needle biopsy which, contrary to previously published cases, can be managed conservatively.

Background Chyle leak (CL) is an uncommon complication of pancreatico‐duodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate incidence of CL following PD and identify risk factors. Following a literature review, we have proposed a management algorithm. Methods This is a retrospective review of all patients who underwent PD between January 2006 and April 2020 at a tertiary hepatopancreaticobiliary unit in the UK. The following data were obtained: age, gender, American Society of Anesthesiologists grade, body mass index, co‐morbidities, duration of surgery, tumour histology, length of stay and mortality. Results A total of 560 patients were included. Seventeen developed CL (3.04%). Median age was 64 years (range 50–81). Sixteen (94.1%) patients still had their surgical drain in at the time of CL diagnosis. One (5.9%) did not and had free intra‐abdominal fluid on computed tomography; a diagnosis was made after an ultrasound‐guided drain had been inserted. CL patients were more likely to have higher body mass index (mean 30.5 kg/m2 (range 17–43) versus 26.7 kg/m2 (22–38)) (P = 0.02) and longer duration of operation (mean 6.2 h (range 4.3–9.0) versus 5.6 (3.0–11.0)) (P = 0.03). All cases of CL resolved without operative intervention. CL did not affect length of stay (median 10 days (range 4–41) versus 11 (4–34)). Conclusions In our series, 3.04% of patients who underwent PD developed CL. No patients required a return to theatre, and none had CL recurrence.

In this single-institution study, the diagnosis of VTE was significantly associated with overweight and obesity. Further study is needed to fully define this association.

Background Pancreatoduodenectomy (PD) remains the only curative‐intent treatment option for patients with cancer affecting the head of the pancreas. It is high‐risk and overall morbidity is around 40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure‐specific complications are possible. An in‐depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance. We aimed to consolidate the recent literature on preselected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastrojejunal leak, postpancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)). Methods A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included. The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta‐analyses and 35 single/multicentre studies). Results Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0–25.9%, BL: 3.0–7.9%, gastrojejunal anastomotic leak: 0.4–1.2%, PPH: 7.3–13.6%, cholangitis: 0.05–21.1% and CL: 2.6–19.0%. Numerous risk factors, both modifiable and non‐modifiable, were identified for each. Conclusion Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case–control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.