Browsing by Author "Ghimire, Pradeep"
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Publication Adhesive Small Bowel Obstruction: A Review(Nepal Medical Association, 2023) Ghimire, Pradeep; Maharjan, ShaileshAbstract Adhesion is a leading cause of small bowel obstruction. Adhesive small bowel obstruction has significant challenges in diagnosis, treatment and prevention with considerable impact on morbidity and socioeconomic burden. Small bowel obstruction caused by adhesion or any other aetiology is clinically indistinguishable due to similar clinical presentation. Computed Tomography scans and water-soluble contrast studies are more specific in diagnosis and possess value in predicting the need for surgery. Surgical management is indicated only in complicated cases or failed conservative treatments with the majority resolving with non-operative management. However, there is no clear-cut consensus about the timing of operative intervention. Meticulous surgical practice is the keystone in preventing adhesion formation despite the availability of numerous pharmacological and surgical strategies. This review aims to update the current knowledge of the pathophysiology of adhesion formation, treatment options and various prevention modalities of adhesive small bowel obstruction.Publication Perforated Caecum in a Left-sided Amyand’s Hernia: A Case Report(Nepal Medical Association, 2023) Jha, Saurav; Kandel, Arjun; Baral, Barsha; Ghimire, PradeepAbstract Amyand’s hernia is a rare type of inguinal hernia with an appendix inside an inguinal hernia sac. Most cases are diagnosed intraoperatively during hernia repair. A 66-year-old male was received at the Emergency Department with complaints of acute onset abdominal pain, vomiting, and groin swelling. The patient was diagnosed with obstructed left inguinoscrotal hernia with suspected bowel perforation. Following the emergency laparotomy, the intraoperative picture depicted a leftsided Amyand’s hernia with a perforated caecum in the hernia sac. Mobile caecum, malrotation, situs inversus, and excessively long appendix denoted it to be the prime factors for the left-sided Amyand’s hernia. A diverse range of pathological features and presentations might complicate the diagnosis and management of Amyand’s hernia and all in all treatment has to be individualized according to the intraoperative finding.Publication Postoperative Pain after Laparoscopic Cholecystectomy in a Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Shrestha, Binod Bade; Lakhe, Gajal; Ghimire, PradeepAbstract Introduction: Laparoscopic cholecystectomy, being minimally invasive, is widely accepted in comparison to open cholecystectomy. The major benefits are small incision, less wound pain, rapid recovery, shorter hospital stay and earlier return to activities. Although, trauma and injury are limited in laparoscopic cholecystectomy; it is not a pain free surgery. Hence, we aimed to find the prevalence of pain at wound site after laparoscopic cholecystectomy at various time intervals in post-operative period. Methods: The descriptive cross-sectional study was conducted among 125 patients who belonged to American Society of Anesthesiologists grade I & II patients, with diagnosis of symptomatic gallstone disease from October, 2022 to September, 2023 in a tertiary care hospital after ethical approval was obtained from Institutional Review Board (Reference number: MEMG/483/IRC). Total sampling was done in this study. The post-operative pain at wound site was measured at 12, 24, 36 and 48 hours. Data were analyzed using Statistical Package of Social Sciences 21.0. Results: At 12 hours postoperatively, 2 (1.60%) patients complained of severe pain, 120 (96%) patients reported moderate pain and 3 (2.40%) patients expressed their pain as being mild. Likewise, at 24, 36 and 48 hours postoperatively, none of the patients suffered from severe pain. At 24 hours post-operative, 105 (84%) patients reported moderate pain which gradually declined over 48 hours. At 36 and 48 hours post-operative mild pain was reported by 85 (68%) and 117 (93.60%) patients. The moderate pain was complained by 40 (32%) and 8 (6.40%) patients. Conclusions: The majority of patients suffered from mild to moderate pain after laparoscopic cholecystectomy, the intensity of which decreased over 48 hours.