Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography (CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.

The profile of acute-on-chronic liver failure (ACLF) has not been reported from western India. This study was undertaken to analyze the etiology and clinical profile of patients with ACLF and correlate these with outcome. Fifty-four consecutive cases of ACLF were investigated for underlying chronic liver disease (CLD) and acute insult and followed up for 6 months. Mortality, Child–Pugh score, and model for end-stage liver disease (MELD) score were recorded. The most common etiologies of CLD were hepatitis B (29.6 %) and cryptogenic (27.7 %). Prognosis was worse in patients with hepatitis B or alcohol as cause of CLD (mortality 79 %). Acute viral hepatitis A or E was the commonest cause of acute insult (33.3 %) and with statistically better outcome (60 % survival) as compared to sepsis, gastrointestinal bleed, or flare of HBV (survival 5 %, p < 0.05). On univariate analysis age, past history of decompensation, leukocytosis, serum bilirubin and creatinine, international normalized ratio, presence of spontaneous bacterial peritonitis, Child–Pugh score and hepatorenal syndrome were significant predictors of mortality. Multivariate analysis revealed a MELD score of >27 and presence of encephalopathy as independent predictors of mortality. Patients with ACLF had high mortality especially when they had underlying chronic hepatitis B or alcoholic liver disease. Presence of encephalopathy and MELD score were independent baseline predictors of mortality. Child–Pugh score was helpful for prognostication.

Background:The risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infections through exposure to blood or its products and contact with other body fluids is high amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs. Aims: To determine the prevalence of HBV and HCV, their possible association with occupational and non-occupational risk factors. We also studied the prevalence of vaccination for hepatitis B in different subgroups of study population. Materials and Methods: In this cross-sectional study, total 1347 hospital staffs were screened for hepatitis B and hepatitis C. HBV is detected by HBsAg testing, and HCV is detected by anti-HCV testing by ELISA method. Positive results were confirmed by HBV DNA testing (Qualitative) and HCV RNA testing (Qualitative). A questionnaire used to collect data from study participants was pre-designed by the authors. Results: Out of total 1347 hospital staffs screened, 6 (0.4%) were HBsAg-positive and 2 (0.1%) were anti-HCV-positive. Only 54% had a history of complete vaccination, and 0.3% had incomplete vaccination. Vaccination coverage was highest in residents (76.7%), medical students (68.9%), nursing (66.1%), and teachers (61.4%) and lowest in servants (5.4%), office staff (6.6%), and lab technicians (24.3%). Awareness about the risk factor for transmission of HBV and HCV and complication related to them was 77.7%. It was highest in teachers (93.9%) and residents (97.8%), lowest in servants (16.3%). No statistically significant difference in the exposure to various risk factors among those who are HBsAg or anti-HCV-positive and HBsAg or anti-HCV-negative. Conclusions: The prevalence of HBV and HCV infection is not high in hospital staff than general population. Hepatitis B vaccination coverage was below expectation in all the subgroups even in resident doctors and teachers.

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