Fetus in fetu (FIF) is an extremely rare condition in which malformed fetus is found most commonly in the retroperitoneum of living twin. It occurs in about 1 in 500 000 live births and less than 200 cases have been reported in medical literature. We report FIF in a 17-year-old woman unlike other cases which were usually detected in early age and in male gender. This is the eighth case of adult FIF and the first case of FIF in adult woman worldwide. Preoperative diagnosis of FIF on CT was made and planned for exploratory laparotomy. The excised malformed fetus in a sac was proven as FIF on the basis of histopathological examination. In view to avoid such late presentation, early detection of FIF with radiological imaging in clinically suspected case is recommended. Surgical excision is the ideal treatment even teratoma is the differential diagnosis.

HighlightsAn interparietal inguinal hernia with undescended testis & obstructed external ring is a rare presentation.In Interperital hernia, the sac passes between the layers of the abdominal wall.Pre-operative diagnosis even with the help of USG & CT is really a challenging issue.Treatment is surgical exploration which also confirms the final diagnosis.

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Background: Early nasogastric feeding has shown beneficial effect in the low socioeconomic group of patient with severe acute pancreatitis (SAP). The current randomized controlled study was performed to assess the effect of early nasogastric feeding as compared to total parenteral nutrition (TPN).Methods: Fifty patients admitted with diagnosis of SAP were randomly allocated to receive nnteral feeding (EF) (at the rate of 25 ml/hour and was gradually increased up to 100 ml/hr) or TPN within 24 hours of hospital admission. The nutritional regimen was aimed to be iso-caloric between the two groups. Patient’s demographics, hospital stay, nutrition, total cost, complication, and mortality were observed for 1 month in follow up.Results: All fifty patients were completed the study. Patient demographics were similar in both groups. 38/50 belonged to low socioeconomic status in the study group (Twenty in EF and eighteen in TPN group). The complications were significantly lower in EF group (pancreatic infection (11 vs. 4, p=0.037), central venous catheter infection (EF=0 vs. TPN=8, p=0.002), multiorgan failure (EF=5, TPN=12, p=0.037). Early recovery in EF group was significant with the mean duration of hospital stay of 6.76 days as compared to 10.4 days in the TPN group. The mean expenditure in the EF group was 1268 as compared to 13688 Indian rupees in the TPN group.Conclusions: This study shows that early EF improves early recovery, lower complications and cost effective measure in SAP especially in low socioeconomic group of patients.

Highlights As per the available literature this is the first case of COVID 19 positive patient with gunshot injury with successful outcome. Effective peri-operative and post-operative care in a COVID 19 positive patients results in better outcome. Delay in emergency surgeries should be avoided in view of awaited COVID report. Universal precaution and multidisciplinary approach have pivotal role in surgical care during COVID -era.