Publications by authors named "Dinesh Prasad Koirala"

5 Publications

  • Page 1 of 1

Forshal type IE appendiceal intussusception: A case report.

Int J Surg Case Rep 2021 Jul 29;84:106151. Epub 2021 Jun 29.

Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Nepal.

Introduction: Appendiceal intussusception is a rare condition. Clinical features are not specific for it. Patients may present with abdominal pain and vomiting. These symptoms represent a variety of abdominal pathology. Preoperative diagnosis is difficult because of the non-specific clinical features. We present a case report of a child who initially presented with ileocolic intussusception.

Case Presentation: This is a case report of a 5-years-old boy with abdominal pain and vomiting. He had an ileocolic intussusception 2 days back, and was successfully managed by hydrostatic reduction and discharged. On ultrasonography, an intussusception was identified in the ileocaecal region. Hydrostatic reduction failed this time and laparotomy was performed. On laparotomy, there was complete intussusception of the appendix with normal ileocaecal junction. Appendectomy was performed. Post-operative period was uneventful.

Discussion: Appendiceal intussusceptions are mostly diagnosed intra-operatively. The clinical features may mimic various other acute and chronic abdominal conditions. Type IE appendiceal intussusception, as described by Forshal, is a rare condition. Appendectomy with a rim of the caecum is the procedure of choice.

Conclusion: Though ileocaecal intussusceptions are common in children, appendiceal intussusceptions are rare and are usually diagnosed during the operative procedure. Radiologists and pediatric surgeons should be aware of this rare entity. Appendectomy is the treatment of choice in most of the appendiceal intussusceptions.
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http://dx.doi.org/10.1016/j.ijscr.2021.106151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258857PMC
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

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

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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