Browsing by Author "Bhandari, R S"
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Publication Annular pancreas in a patient with malignant obstructive jaundice: A case report(Institute of Medicine, 2017) Shah, S; Bhandari, R SAbstract Majority of cases with annular pancreas are asymptomatic. Common presentations in symptomatic patients are abdominal pain, nausea and vomiting. Jaundice is very rare presentation of annular pancreas. We are presenting a case of 40 years male with annular pancrea. He presented with jaundice, anorexia and weight loss. Contrast enhanced computed tomography shows annular pancreas with extrahepatic as well as intrahepatic bile duct dilatation. Magnetic resonant cholangiopancreatography showed abrupt narrowing of distal common bile duct with upstream dilation of biliary duct suggestive of distal cholangiocarcinoma. This case illustrates the important of evaluation for malignant cause of obstructive jaundice in patients with annular pancreas presented with jaundice, anorexia and weight loss Key words: Annular pancreas, Distal cholangiocarcinoma, JaundicePublication Gall Bladder perforation by Typhoid Complication(Nepal Health Research Council, 2009-04) Singh, K P; Bhandari, R SPublication Management of adhesive intestinal obstruction(Institute of Medicine, 2010) Niyaf, A; Bhandari, R S; Singh, K PAbstract Introduction: Adhesive intestinal obstruction is an inevitable complication of abdominal surgeries. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Commonest cause of bowel obstruction in developed countries is postoperative adhesions with extrinsic compression of the intestine. Most of them can be managed conservatively. Methods: A retrospective study of 30 patients admitted with the diagnosis of post operative adhesive partial bowel obstruction was conducted by analyzing their medical records. Demographic data, clinical presentation including duration, previous surgical procedures, treatments received for the condition and successful conservative approach versus requirement of operative intervention were assessed. Results: The median age was 31 yrs, most in their third decade of life. Male predominance was noted. Pelvic surgeries and gynecological surgeries (26%) were found to be the most common cause of adhesive bowel obstruction followed by appendectomy (16%). More than two third of the patients (76.7%) developed symptoms within two years of the initial surgery. Successful conservative treatment was noted in 22 patients (73.3%) and discharged on fourth day of admission. Eight patients (26.6%) underwent surgery. They all underwent adhesiolysis and had good outcome. Conclusions: The time-honored practice of expectant management of adhesive partial bowel obstruction has equally good outcome, as compared to various interventions practiced. Keywords: Adhesive bowel obstruction, conservative managementPublication Surgical management of extrahepatic portal vein obstruction at University Hospital(Institute of Medicine, 2017) Shah, S; Ghimire, B; Kansakar, P B S; Bhandari, R S; Lakhey, P J; Vaidya, P; Singh, Y PAbstract Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO. Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed. Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups. Conclusions: Surgical management for EHPVO have good perioperative and short term outcome. Keywords:Esophageal varices, Hypersplenism, Portal biliopathy,Portal vein obstruction