Comparison of Short-Course versus Conventional Antimicrobial Duration in Mild and Moderate Complicated Intra-Abdominal Infections: A randomised controlled trial

Objectives: Studies have shown the feasibility of short-course antimicrobials in complicated intra-abdominal infection (CIAI) following source control procedure (SCP). This study was carried out to compare post-operative complication rates in short-course (5 days) and conventional (7–10 days) duration groups after antimicrobial therapy. Methods: This was a single-centre, open-labelled. randomised control trial conducted from July 2017 to December 2019 upon patients with CIAI. Patients who were haemodynamically unstable, pregnant and had non-perforated, non-gangrenous appendicitis or cholecystitis were excluded. Primary endpoints were surgical site infection (SSI), recurrent intra-abdominal infection (IAI) and mortality. Secondary endpoints included time till occurrence of composite primary outcomes, duration of antimicrobial therapy, the length of hospital stays, antimicrobial-free interval, hospital-free days at 30 days’ interval and the presence of extra-abdominal infections. Results: Overall, 140 patients were included whose demographic and clinico-pathological details were comparable in both groups. There was no difference in SSI (37% vs. 35.6%) and recurrent IAI (5.7% vs. 2.8%; P = 0.76), and no mortality was observed in either groups. The composite primary outcome (37% vs. 35.7%) was also similar in both groups. Secondary outcomes included the duration of antimicrobial therapy (5 vs. 8 days; P < 0.001) and length of hospitalisation (5 days vs. 7 days; P = 0.014) were significant. Times till occurrence of SSI and recurrent IAI, incidence of extra-abdominal infection and resistant pathogens were comparable. Conclusion: Short-course antimicrobial therapy for 5 days following SCP for mild and moderate CIAI was comparable to conventional duration antimicrobial therapy, indicating similar efficacy. Keywords: Abdominal Abscess; Antibiotic Prophylaxis; Antimicrobial Stewardship; Appendicitis, Perforated; Drug Resistance, Microbial; Intra-abdominal Infection; Peritonitis; Surgical Wound Infection

Double Trouble – Synchronous Primary Malignant Neoplasms: A Case Report

Synchronous primary malignancy (SPM) is rare. We herein present a case of gastric carcinoma (GC) and renal cell carcinoma (RCC) to highlight the fact that the occurrence of RCC as a synchronous tumor along with GC is rare and that a high index of suspicion of SPM should be considered before declaring it as a metastasis. A 60-year-old male presented with abdominal pain and vomiting for 4 months, and a mass was incidentally found in the lumbar region. The patient was diagnosed with SPM of the GC and RCC. Chemotherapy was given, followed by total gastrectomy; radical nephrectomy was performed. The patient is currently on follow-up. Complete history taking and thorough physical examination of patients with malignancy is instrumental in ruling out metastasis and other synchronous lesions, especially in GC. Synchronous malignancies should be treated with the multidisciplinary team, as there is no consensus in the treatment protoco

Broken stent of endoscopic retrograde cholangiopancreatography mimicking a common bile duct stone: a case report

Long standing biliary stent for biliary stricture may have complications like cholangitis, cholecystitis, stent fracture and stent migration. Treatment includes re-do endoscopic retrograde cholangiopancreatography, removal of fractured stent and restenting. Authors report a case of fractured biliary stent mimicking as distal common bile duct stone. Patient presented with features of cholangitis with history of endoscopic stenting 6 years back but lost follow up thereafter. Ultrasound showed 2cm calculus in distal common bile duct and the stent was seen on endoscopy through the papilla in the duodenum. Contrast enhanced computed tomography of abdomen showed radio opaque dense shadow in the distal common bile duct suggesting possibility of broken biliary stent. Redo endoscopic retrograde cholangiopancreatography failed to remove the fractured stent. A new stent was placed without complications. Patient underwent open common bile duct exploration and the fractured stent was removed. Patient recovered completely after the procedure