Publications by authors named "Bibek Man Shrestha"

9 Publications

  • Page 1 of 1

Cyclopia with proboscis: A rare congenital anomaly.

Clin Case Rep 2021 Jul 16;9(7):e04466. Epub 2021 Jul 16.

Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital Kathmandu Nepal.

Cyclopia with a proboscis, a rare congenital anomaly, and a severe form of holoprosencephaly occur as a result of incomplete separation of prosencephalon into two halves of hemispheres during organogenesis. A prenatal anomaly scan can help in the early detection of the condition and timely termination of the pregnancy.
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http://dx.doi.org/10.1002/ccr3.4466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283846PMC
July 2021

Symptomatic familial adenomatous polyposis in an adolescent: A case report.

Int J Surg Case Rep 2021 Jul 26;84:106118. Epub 2021 Jun 26.

Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.

Introduction: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome characterized by several adenomatous polyps of the gastrointestinal mucosa with a universal risk of colorectal cancer in a lifetime. FAP is usually asymptomatic in the first decade of life.

Case Presentation: We report a case of a 13-year-old girl diagnosed with FAP who presented in our center with symptoms of hematochezia along with a positive history of the untimely demise of her father and elder sister with similar symptoms.

Discussion: FAP is an autosomal dominant disease affecting both male and female equally with variable penetrance. Diagnosis is made by finding hundreds to thousands of adenomatous polyps in the colon and rectum, and molecular analysis of the APC gene which forms the definitive diagnosis. Prophylactic laparoscopic total proctocolectomy with ileorectal anastomosis is a safe and feasible surgical option with a low risk of complications among adolescents. An endoscopic/colonoscopic procedure is recommended every 6 to 12 months after surgery to assess the anastomosis site, pouch, and residual rectum.

Conclusion: FAP, a rare disease entity in adolescents should be managed by appropriate diagnostic procedures, early prophylactic surgery, and regular lifelong follow-up.
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http://dx.doi.org/10.1016/j.ijscr.2021.106118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254105PMC
July 2021

Cecal gastrointestinal stromal tumor causing ileocolic intussusception in an adult: A rare case report.

Int J Surg Case Rep 2021 Jul 8;84:106097. Epub 2021 Jun 8.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Introduction And Importance: Cecal gastrointestinal stromal tumors (GIST) constitute a rarer subtype of all GISTs. Rarely, it can present with ileocolic intussusception in adults making it a challenging diagnosis due to non-specific clinical features.

Case Presentation: A 30-year previously healthy woman presented with lower abdominal pain and a distended abdomen who was subsequently diagnosed with ileocolic intussusception on a CT scan. Intraoperatively, a pedunculated polypoid hard mass was identified in the cecum and thus, a standard right hemicolectomy was performed with the suspicion of malignancy. Histopathology of the resected mass confirmed CD117 negative, spindle type GIST.

Discussion: Cecal GIST presenting in the form of ileocolic intussusception is rare. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete resection decreases the disease recurrence.

Conclusion: Intussusception in an adult can be the first manifestation of underlying malignancy like GIST. Complete surgical resection of the tumor with a negative margin offers long-term survival.
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http://dx.doi.org/10.1016/j.ijscr.2021.106097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219755PMC
July 2021

Hirschsprung disease with Edward syndrome: A rare association: A case report.

Int J Surg Case Rep 2021 Jul 9;84:106084. Epub 2021 Jun 9.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Edward's syndrome (ES) occurs as a result of trisomy of chromosome 18 and is associated with multisystem congenital anomalies. The association of ES with various gastrointestinal malformations but Hirschsprung disease (HD) is well documented.

Case Presentation: A female infant on her 5th day of life presented with episodes of bilious vomiting along with abdominal distension and no passage of stool. The child had a small head and prominent occiput, low set abnormal ears, small jaw, upturned nose, widely spaced eyes, small neck with widely spaced nipples, clenched hands with overlapping fingers, flexed big toe, and prominent heels.

Clinical Discussion: Edward syndrome is associated with multisystem congenital abnormalities of which gastrointestinal abnormalities make up the most part. The condition can be identified by fetal ultrasound screening. Surgical correction of associated congenital anomalies at different times along with lifelong supportive management is important.

Conclusions: Edward syndrome can present as Hirschsprung disease as a part of associated gastrointestinal Malformation. Often, early identification and termination of the pregnancy in antenatal life can reduce the suffering. Surgical correction of associated anomalies along with supportive care forms the cornerstone of management. However, the prognosis remains poor.
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http://dx.doi.org/10.1016/j.ijscr.2021.106084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196216PMC
July 2021

Jejunal varices with extra hepatic portal vein obstruction: A case report.

Int J Surg Case Rep 2021 Jun 12;83:105964. Epub 2021 May 12.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Introduction And Importance: Extrahepatic portal vein obstruction (EHPVO) with portal hypertension is rare in children. Intestinal varices as new collaterals accompanying portal hypertension are very rare.

Presentation Of Case: We report an unusual case of a 12-year-old boy with EHPVO with gastrointestinal bleeding from ectopic jejunal varices, without any gastroesophageal varices.

Discussion: Portal hypertension is the most common cause of EHPVO. Among various ectopic varices, intestinal varices are found distal to the duodenum and present with complaints of hematochezia, melena, or intraperitoneal bleeding. The diagnosis of the EHPVO is aided by imaging investigations like Doppler ultrasound, computed tomography, or magnetic resonance imaging. A multidisciplinary team including gastroenterologists, interventional radiologists, surgeons, and intensivists is crucial in the management of ectopic varices.

Conclusion: Jejunal varices must be considered in the differential diagnosis of gastrointestinal (GI) hemorrhage in patients with a negative source of bleed on upper and lower GI endoscopy.
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http://dx.doi.org/10.1016/j.ijscr.2021.105964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141758PMC
June 2021

Jejunal GIST masquerading as an ovarian mass: A case report.

Int J Surg Case Rep 2021 May 3;82:105960. Epub 2021 May 3.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Introduction And Importance: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal tract. Jejunal GIST is the rarest subtype. Large GIST can present with an abdominopelvic mass which can be preoperatively misdiagnosed as a gynecological tumor.

Case History: A 44-year regularly menstruating woman presented with lower abdominal pain which was diagnosed as a malignant ovarian tumor preoperatively with an MRI. However, intraoperatively, a lobulated mass was present in the abdominal cavity arising from a jejunal portion of the small intestine. With an intraoperative diagnosis of jejunal GIST, the mass was excised and jejunum anastomosed. Histopathology examination report showed GIST which was further confirmed by immunohistochemistry.

Discussion: GIST presenting as a large abdominopelvic mass can mimic a gynecological tumor. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete excision can decrease the disease recurrence.

Conclusion: Gynecologists should keep in mind that primary gastrointestinal tumors can present as a pelvic mass. A proper histopathological examination helps to confirm the diagnosis. Complete surgical removal of the tumor should be obtained as it determines the prognosis of the disease.
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http://dx.doi.org/10.1016/j.ijscr.2021.105960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114170PMC
May 2021

Squamous cell carcinoma arising within choledochal cyst managed by pancreaticoduodenectomy: A case report.

Int J Surg Case Rep 2021 May 27;82:105919. Epub 2021 Apr 27.

Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Introduction And Importance: Choledochal cysts (CC) are rare cystic dilatation of the biliary trees. Malignancy is one of the important significant findings in CC and its incidence increases with age. Associated squamous cell carcinoma of the choledochal cyst is an uncommon pathological finding.

Case Presentation: We present a 21-year-old male diagnosed with type 1 CC and planned for excision of the cystic dilated extrahepatic biliary tract with hepaticojejunal anastomosis in Roux-en-Y but underwent pancreaticoduodenectomy due to intraoperative palpable mass of CC which was adhered to the duodenum and pancreatic head. Histopathology of the excised specimen revealed squamous cell carcinoma (SCC) of the choledochal cyst.

Discussion: CC represents a rare biliary cystic disease. Though infrequent, malignant transformation in CC includes cholangiocarcinoma, adenocarcinoma, and rarely SCC. The post-operative management for SCC in CC is ill-defined and carries a grave prognosis.

Conclusion: The choledochal cyst should be completely excised wherever possible to avoid the possible malignant transformation in CC including SCC.
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http://dx.doi.org/10.1016/j.ijscr.2021.105919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102759PMC
May 2021

Perforation of gastroesophageal junction, stomach, and diaphragm following blunt abdominal trauma: A near miss: A case report.

Int J Surg Case Rep 2021 Apr 17;81:105786. Epub 2021 Mar 17.

Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. Electronic address:

Introduction: Blunt abdominal trauma causing Gastro-esophageal junction (GEJ), diaphragm, and gastric perforation in children is a very rare occurrence. However, the injury is serious and life-threatening with significant morbidity and mortality.

Presentation Of Case: We report an unusual case of a 14-year-old boy with an accidental fall from the tree with blunt abdomen trauma with a perforating injury to GEJ, stomach, and diaphragm.

Discussion: Multiple vital organs in the abdominal cavity are vulnerable to damage in blunt abdominal trauma. The rarity of perforation, diagnostic delay, and early septic occurrence sums up to higher patient morbidity and mortality. A high degree of suspicion and urgent laparotomy and surgical repair forms the cornerstone in management.

Conclusion: Early suspicion along with effective resuscitation and early laparotomy and surgical repair is crucial for survival and optimal outcome of the patient.
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http://dx.doi.org/10.1016/j.ijscr.2021.105786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041729PMC
April 2021

Impalement injury of the perineum with an iron rod with a minimal injury: A near miss: A case report.

Int J Surg Case Rep 2021 Mar 11;80:105645. Epub 2021 Feb 11.

Department of Pediatric Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Penetrating perineal injury in children is uncommon. However, the injury is serious and life-threatening with significant morbidity and mortality.

Case Presentation: We report an unusual case of a 13-year-old boy with an accidental perineal impalement injury by an iron rod, which pierced through the perineum and exited through the left loin, however with minimal external and internal injuries.

Clinical Discussion: Multiple vital organs in the pelvic space are vulnerable to damage in perineal impalement injury. Vital organ injury, amount of blood loss, and effectiveness of the resuscitation determine the outcome of an impalement injury. Urgent laparotomy forms the cornerstone in management as all the potential injuries can be identified and managed immediately.

Conclusion: Effective resuscitation and accurate assessment of the associated injuries along with proper pre-hospital care with a multidisciplinary approach is crucial for the survival and optimum outcome of the victim.
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http://dx.doi.org/10.1016/j.ijscr.2021.105645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900347PMC
March 2021
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