Browsing by Author "Kumar, M"
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Publication Descending necrotizing mediastinitis: A fatal complication of neglected esophageal foreign body(Kathmandu University, 2007) Ghimire, A; Bhattarai, M; Kumar, M; Wakode, PTDescending necrotising mediastinitis due to a neglected esophageal foreign body is uncommon. It is a lethal disease if it develops with full blown clinical picture. A case is reported of descending necrotising mediastinitis caused by a foreign body in oesophagus which is rarely reported in world literature. It is emphasized that prompt diagnosis and aggressive surgical mediastinal drainage is very important for the survival of these patients. Delayed diagnosis and treatment in our case may have been the cause of death of the patient. Delayed diagnosis in our case is due to the unavailability proper health facility in remote area in developing countries like Nepal. Key words: Descending necrotising mediastinitis, foreign body, oesophagus, fatal complicationPublication Iliopsoas abscess: Analysis and perspectives from an endemic region of Eastern Nepal(Kathmandu University, 2007) Yadav, RP; Agrawal, CS; Adhikary, S; Kumar, M; Regmi, R; Amatya, R; Gupta, RKAbstract Objective: To evaluate the clinical profile and outcome in patients with iliopsoas abscess. Methods: A descriptive study was carried out in B.P. Koirala Institute of Health Science, Dharan, Nepal from February 2005 to March 2006. The medical records of all thirty six patients admitted in surgery ward with diagnosis of iliopsoas abscess during the study period were analyzed. Results: Thirty six patients were included the study. There were 22 (61.1%) males and 14 (38.9%) females with a mean age of 24.33 ±19.19 years. Demographic distribution of the patients revealed the highest number 13 (36.1%) from Sunsari district, eastern part of the country. Right sided unilateral involvement was the most common presentation and only 2 cases had bilateral involvement. In none of our patients the dorsolumbar spine radiograph revealed any involvement of the bone. The most common complaints were pain in lower abdomen and lump in iliac fossa with flexion deformity at hip joint. All the patients underwent open surgical drainage and their outcomes were analyzed in term of cure, morbidity and mortality. Staphylococcus aureus was the most common organism 24 (61.5%) isolated. Twenty two (91.66%) of Staphylococcus aureus samples were sensitive to ciprofloxacin. There was one mortality in the group who died of septicaemia secondary to necrotizing fascitis. Six patients had wound infection, which were cured by regular dressing. Conclusion: On the basis of our experience and review of available relevant literature, we can conclude that a high index of suspicion and awareness of the varying clinical picture are required to diagnose this condition properly. Ultrasonography should still be the preferred imaging modality as it is cheap, safe, cost effective and readily available. Ciprofloxacin should be used as a first line drug. Image guided aspiration may be practical in selected cases having little pus and traditional open drainage should be considered without hesitation. Key words: Psoas abscess, ultrasound abdomen, bacteriology, operative interventionPublication Intussusception of Small Intestine as a Result of Inflammatory Fibroid Polyp Causing Small Bowel Obstruction in an Adult Patient(Kathmandu University, 2017) Grover, AS; Kumar, M; Yadav, R; Sharma, A; Chowdhary, K; Zaman, M; Chowdhary, A; Bawa, AABSTRACT Intussusception is the telescoping of one segment of bowel into the adjacent segment. It is more commonly seen in children,however rarely encountered in adult patients. Proximal segment of bowel is called intussusceptum which is intussuscepted into the lumen of the adjacent distal segment known as intussuscipiens. There is always a lead point causing this disorder especially in adults. We presented a case of a 45 year old man who presented in emergency department of our institute with history and clinical features of acute intestinal obstruction since 10 days. Patient was resuscitated, investigated and taken for exploratory laparotomy under General anaesthesia. Segment of involved small gut was resected and well circumscribed polypoidal mass was found in intussuscepted bowel. Histopathological examination of the specimen revealed the features of inflammatory fibroid polyp. KEY WORDS Inflammatory fibroid polyp, Intussusception, Small bowel obstructionPublication Visualization of Normal Appendix in Multidetector Computed Tomography(Institute of Medicine, 2015) Ansari, MA; Kumar, M; Subedi, KAbstract Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Visualization of normal appendix is important to exclude the possibility of appendicitis. With the widespread use of multidetector computed tomography (MDCT) for evaluation of acute abdomen, the normal appearance and rate of visualization of appendix has to be defined. Methods: This was a prospective cross sectional study involving 250 patients undergoing abdominal CT for various indications in Tribhuvan University Teaching Hospital between October 2012 and September 2013. One hundred twenty seven patients were female and 123 were male. Age ranged from 17 years to 73 years. CT scans of the patients were obtained with a 16 slice CT scanner with IV contrast. In all patients, there was no clinical suspicion of acute appendicitis or history of appendectomy. Appendix was searched in these patients by tracing caecum. Results: Appendix was visualized in 215 patients, 111 females and 104 males. Appendix was not visualized in 35 patients, 16 females and 19 males. In total appendix was visualized in 86% of patients (87.4% females and 84.6% males). Conclusion: MDCT is an accurate imaging modality for detection of appendix, whether normal or pathological. Visualization rate of normal appendix by CT scan is higher ranging up to 96% as shown in various studies. Thin collimation, use of contrast and multiplanar reconstruction may be the reason for increased rate of visualization of normal appendix. Keywords: aapendix, multidetector computed tomography