Journal of Society of Surgeons of Nepal

A Rare Presentation of Lipoma: Case of Preputial Lipoma

Aakansh Jain — 2023-12-31

Penile lipoma itself is a very rare finding. Over which preputial lipoma is not reported previously so this case of a 33-year-old married male is probably the first documented case of preputial lipoma where it causes sexual dysfunction.

A Juxta-Articular Myxoma of the Thumb in a young male: A case report

Sudhanshu Vinay Tripathi — 2023-12-31

Juxta-articular myxomas are benign tumours that are most commonly associated with larger joints. Cases involving hand have been rarely reported till date. We present a case of a juxta-articular myxoma at the metacarpophalangeal joint of the thumb in a 30-year-old male patient. The preoperative diagnostic work-up included ultrasound and X-ray of left hand. The histopathological examination of the resected tumor confirmed the diagnosis. Follow-up ultrasound six months after surgery revealed no obvious recurrence. At 6 months, the patient had full range of motion without pain.

Left Side Obturator Hernia With Multiple Ileal Diverticula : A Rare Case Report In A 72 Year Old Female

Pradeep Kumar Verma — 2023-12-31

Obturator hernia is an extremely rare type of hernia that presents with signs and symptoms of intestinal obstruction. Its early diagnosis is difficult because the signs and symptoms are non-specific. A 72-year-old woman was admitted to our hospital in the emergency ward with complaints of intermittent abdominal colicky pain, abdominal distension, and bilious vomiting from last six days. The abdomen skiagram showed an obstructed loop of the bowel in the pelvis. After initial resuscitation, an exploration of the abdomen was planned. The patient also had multiple ileal diverticula in the terminal ileum. The only treatment for the obturator hernia is surgery.

Hemorrhagic Rupture of Simple Hepatic Cyst: A Case Study

Manish Gautam — 2023-12-31

Symptomatic hepatic cysts are infrequent and their presentation with rupture leading to an hemoperitonium is even more uncommon. This case report illustrates the challenges associated with the diagnosis and management of a ruptured simple hepatic cyst.

We report the case of 72-year-old female, a known case of liver cirrhosis, hypertension, diabetes mellitus, and cholelithiasis who presented to our center with features of acute abdomen and was diagnosed with the ruptured simple hepatic cyst. Deroofing and marsupialization of the cyst was performed.

This case report emphasizes the significance of early recognition and a multidisciplinary approach in managing ruptured simple hepatic cysts. Heightened clinical awareness, coupled with advanced imaging techniques, is crucial for accurate diagnosis and timely intervention.

Reliability of RUT done on endoscopy guided gastric biopsy in detecting Helicobactor Pylori

Wasif Mohammad Ali — 2023-12-31

Introduction: This study was done to identify the reliability of RUT in detecting H. Pylori in patients of gastritis by performing Histopathological examination. Endoscopic biopsy samples were taken from gastritis lesions present in the stomach.

Methods: This was a prospective observational study done at Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University (AMU), Aligarh between May 2021 and May 2022 with a sample size of 230 patients. The endoscopists performed RUT on biopsy samples taken from gastritis lesions and sent another biopsy sample from the same patient for histopathological examination. On the basis of histopathological report, results were compared and analyzed.

Results: In our study the specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of RUT were 60.81%, 67.31% ,78.36%, 46.88% , and 65.22%, respectively.

Conclusion: Our study suggests that RUT can reliably identify Helicobacter pylori infection in gastric mucosa.

Comparison of stone clearance rate based on upper, middle, or lower calyx puncture in Mini Percutaneous Nephrolithotomy (mPCNL)

Kushal Karki — 2023-12-31

Introduction: PCNL is the most common surgical technique used for the management of renal stones, particularly for those with more than 2 cm stones. The aim of this study is to identify which kidney calyx—upper, middle, or lower—when punctured achieves the highest stone clearance rate.

Methods: This was a prospective non-randomised study performed in department of urology, KIST medical college from September 1, 2021 to November 16, 2022. Patients who underwent PCNL were evaluated with detailed history, examination, and investigation. All the patients who fulfill the inclusion criteria during study period were included in the study. After preoperative investigation PCNL was done according to standard protocol. Perioperative complication recorded in Performa. Stone-free status was checked after 2 months of surgery with ultrasonography.

Results: 100 patients were included in this study among which 59 were male. The mean age of patients was 33.35 years [range 18-65 years]. Upper, middle and lower pole puncture was done in 23%, 33% and 44% patients respectively. The mean stone burden of the patient was 380.680 mm2. The average time for surgery according to access was 67.34 mins, 63.12mins, and 64.07 mins for the upper calyx, mid-calyx and for the lower calyx respectively. 84.33% of patients had complete stone clearance after 2 months in the USG examination. 91.3% [21] had stone clearance when approached through the upper calyx. It was 87.8%[29] by mid calyx and 75%[33] by lower calyx. Upper calyx puncture had statistical significance in stone clearance rate [P=0.43, P=0.021, P=0.002]. 11 had CRIF ≤4mm stone in PCS, and the remaining 6 had residual stone >4mm. In our study, thoracic complications were significantly higher in upper calyx puncture 8[30.4%, 8[24.24% in the middle calyx, and 3[6.8%] in lower calyx [P=0.02, P=0.98, P=0.03] respectively.

Conclusion: Upper calyceal puncture can produce the highest stone clearance rate, but it has been associated with significant postoperative morbidity, particularly in the chest. Lower calyx punctures have less intraoperative and postoperative morbidity, but their stone removal rates are lower than those of other procedures. Therefore, the balance between stone clearance rate and morbidity has been achieved using middle calyx puncture.

Tzanaki’s Score Vs Modified Alvarado’s Score In Diagnosing Acute Appendicitis: A Comparative Study In A Tertiary Care Hospital

Ashok Kumar Rajpura — 2023-12-31

Introduction: Acute appendicitis is commonly diagnosed when a patient presents with pain in right iliac fossa. Various Scoring systems are used to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for patients. The purpose of this study was to assess effectiveness of modified Alvarado score and Tzanaki’s Score in the diagnosis of acute appendicitis.

Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which incorporated 200 patients presenting with the signs and symptoms of acute appendicitis. Patients were evaluated by Modified Alvarado score and Tzanaki’s Score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis done by histopathological examination of the operated specimen.

Results: The sensitivity & specificity of Modified Alvarado Score was 84.26% & 72.7% respectively with a positive predictive value of 96.15% & negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7% respectively with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%.

Conclusion: Tzanaki’s scoring system can be used as an effective modality in the diagnosis of acute appendicitis. There is increased sensitivity and diagnostic accuracy in Tzanaki’s scoring when compared to modified Alvarado score.

Ultrasound-Guided Pneumatic Reduction of Intussusception in Children

Sanjay Kumar Sah — 2023-12-31

Introduction: Intussusception, occurring most commonly in 6-month to 3-year-olds, involves bowel invagination with symptoms like abdominal pain, red currant jelly stool, and a palpable mass. The preferred treatment is non-operative, especially in stable cases without contraindications. Non-operative methods include ultrasound-guided hydrostatic and pneumatic reduction, as well as fluoroscopic-guided hydrostatic reduction with barium and pneumatic reduction with air enema.

Methods: The prospective study took place at a specialized pediatric hospital over 36 months period. All children experiencing intussusception underwent abdominal sonographic assessment for diagnosis. Subsequently, an attempt was made to perform ultrasound-guided pneumatic reduction of the intussusception. Exclusions comprised hemodynamically unstable children, those displaying signs of peritonitis or bowel perforation, and those with sonographically identified pathological lead points.

Results: A total of 98 children were treated with ultrasound-guided pneumatic reduction for intussusception.The average age of the patient was 11.38±9.24 months. Ileocolic intussusception was the most common finding in 98.9%. Around 80% of the patients was presented with complaints of severe abdominal pain. In 43.8% of the patients, the duration of symptoms was less than 24 hours. The mean length of intussusception was 3.64 cm. A total of 94 (96%) children had successful reduction of intussusceptions with recurrence found in only two of cases.

Conclusion: Pneumatic reduction of intussusception is a highly effective procedure. It is associated with reduced morbidity and mortality and reduced risk of exploratory laparotomy. The main predictor for the outcome was the duration of symptoms before presentation to the institute, thus early use of pneumatic reduction is advisable.