Tanveer Singh

infection (CDI) is a perpetual problem that leads to increased economic burden, higher healthcare cost, and significant morbidity and mortality. Its treatment remains a challenge. While various treatment approaches have been attempted with different levels of success, robust data establishing the superiority of one approach over the others is lacking. In this article, we review the current evidence pertaining to conventional pharmacological treatment as well as fecal microbiota transplantation (FMT) as a novel, rapidly emerging treatment modality for recurrent CDI.

OBJECTIVES: Shorter hospital stay after pancreatoduodenectomy (PD) is a desired goal. Implementation of enhanced recovery after surgery (ERAS) protocols can possibly help in achieving this target. We aimed to determine the factors influencing the successful implementation of ERAS protocols by analyzing their relation to the surrogate marker of enhanced recovery, namely, duration of hospital stay. METHODS: A retrospective analysis of a prospectively maintained ERAS database of 208 consecutive patients who underwent PD at a tertiary referral care center was done. RESULTS: Two hundred eight patients underwent a classical PD with a median duration of hospital stay of 8 days (range, 4-52 days) with an overall morbidity rate of 34.5% and a mortality rate of 3.8%. The 30-day readmission rate was 4% (8 patients). An elevated body mass index (relative risk, 1.098; 95% confidence interval, 1.015-1.188; P = 0.02) and respiratory comorbidities (relative risk, 8.024; 95% confidence interval, 2.018-31.904; P = 0.003) were independent factors resulting in a longer (>8 days) hospital stay. CONCLUSIONS: Being overweight or obese and respiratory comorbidities are independent predictors of prolonged hospital stay despite the implementation of ERAS protocol. Hypoalbuminemia does not have a direct effect on hospital stay but may predispose the patient to the development of complications.

CONTEXT: There is limited information available about the feasibility and benefits of synchronous resection of liver metastases in patients with pancreatic and periampullary cancer undergoing pancreaticoduodenectomy. OBJECTIVE: We report on our experience with 7 such patients. DESIGN: Analysis of the prospective database was carried out to identify patients who underwent synchronous resection of liver metastases with pancreaticoduodenectomy. PATIENTS: Two-hundred and thirty patients underwent pancreaticoduodenectomy for pancreatic and periampullary cancer in our unit between September 2003 and September 2009. MAIN OUTCOME MEASURES: The primary aim of our study was to determine the survival benefits and the secondary aim was to evaluate their safety and influence on the results of a pancreaticoduodenectomy. RESULTS: Seven patients (3%) underwent synchronous resection of a solitary liver metastasis. In these patients, the operative time and intra-operative blood loss was marginally high as compared to the overall cohort of patients undergoing pancreaticoduodenectomy; however, the complication rates and the duration of the hospital stay were not affected. In patients undergoing resection of liver metastasis, there were 4 recurrences over a mean follow-up of 21 months. CONCLUSIONS: In patients with resectable pancreatic and periampullary cancer, the resection of a solitary liver metastasis can safely be performed together with a pancreaticoduodenectomy; however, its impact on improving survival has yet to be proven.

Acquired ectopic splenic tissue is called splenosis, which is common after the history of trauma or surgical exploration. We present a rare case of intrahepatic splenosis in 36-year-old male patient mimicking a liver neoplasm on imaging however presented with left flank pain for 5 months and had remote history of splenectomy after splenic rupture from trauma. We discuss various imaging modalities and the role of various magnetic resonance imaging sequences and nuclear medicine examination. We also discuss the differentiating features to be kept to make the correct diagnosis along with a brief review of literature. We mentioned signal intensities of splenic lesions and normal signal intensity of spleen in different magnetic resonance imaging sequences and with high suspicion how we can diagnose splenosis and avoid unnecessary biopsy and its result related stress.