Browsing by Author "Thapa, Bijay"
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Publication Duplicate Bladder Exstrophy With Fistula: A Rare Variant of Exstrophy-Epispadias Complex(Nepal Paediatric Society (JNPS), 2021) Thapa, BijayAbstract: Variants of exstrophy are rare anomalies seen in the spectrum of bladder exstrophy-epispadias complex. A seven day old male neonate was admitted in our department with a rare variant of duplicate bladder communicating with exstrophy bladder with fistula. Patient presented with patch of exstrophic bladder just below the low set umbilicus with a normal sized phallus and normally positioned urethral meatus. The baby was managed successfully with surgery and is under regular follow up.Publication Epidemiology, Clinical Pattern and Management Outcome of Paediatric Burn Injuries in Nepal(Nepal Paediatric Society (JNPS), 2021) Thapa, Bijay; Chapagain, Ram Hari; Kayastha, AnjuAbstract: Introduction: Burn injuries are third commonest type of injury in Nepal and 61% of burn victims are children. This represents a significant morbidity and mortality burden for patients and families. This study was carried out to describe epidemiology, clinical pattern and therapeutic outcome of children with burn. Methods: It is a retrospective observational study of routinely collected data of children up to 14 years admitted to the Burns Ward at Kanti Children’s Hospital, Kathmandu, Nepal, from July 2016 to July 2019. Statistical analysis was done on the collected data. Results: Total 935 patients were admitted with an average of 311.7 per year, among which 63% were males and 83.0% were aged five years or under. Patients travelled from all over Nepal for treatment at this hospital. 50.6% of patients presented with fresh burns < 24 hours after injury. Scald burn was the commonest (82.6%). Children under five were more likely to have scald burns, whereas older children more likely to have flame or electric burns. Majority of cases (70%) were of mild burns < 10% TBSA and only 3.2% TBSA > 30%. 68.5% were managed conservatively and 18.4% required debridement and skin grafting. Mean length of stay was 15 days. Overall mortality was 1.0%. In children with > 30% burns mortality was 12.9%. Conclusions: Scald burn was the commonest while proportion of flame burn increases with age. Majority of burns occur in male under five years of age. Most cases presented with < 10% TBSA and were managed conservatively.Publication Omphalocele, Exstrophy of Cloaca, Imperforate Anus, and Spinal Defects Complex: A Case Report(Nepal Medical Association, 2023) Singh, Suraj; Kayastha, Anuj; Thapa, Anupama; Thapa, Bijay; Dahal, SulochanaAbstract Omphalocele, exstrophy of cloaca, imperforate anus, and spinal defects complex is a rare malformation complex that includes omphalocele, cloacal exstrophy, imperforate anus and spinal defects with the incidence of 1 in 200,000 to 400,000 pregnancies and is even rarer in twin gestation. The etiology of this complex is still unclear. Most cases are sporadic. Prenatal screening must be done for diagnosis and appropriate multidisciplinary management of cases. In severe cases, termination of pregnancy is considered. We present a 4-day first twin child with underdeveloped ambiguous genitalia delivered via emergency lower section cesarean section at 32+3 weeks of gestation with giant liver containing omphalocele, cloacal exstrophy, imperforate anus and meningocele with severe pulmonary artery hypertension and non-visualization of right kidney and ureter, absence of uterus, fallopian tubes and right ovary. Separation and repair of the cecum and bladder were done. The ladd procedure was performed. Ileostomy was created and single-stage repair of the abdominal wall was done.Publication Patent Vitello - Intestinal Duct: A Case Report(Nepal Paediatric Society (JNPS), 2021) Thapa, Bijay; Thapa, Anupama; Kayasthya, AnjuAbstract: A wide variety of anomalies may occur as a result of the vitello- intestinal duct (VID) failing to obliterate completely. These anomalies occur in approximately 2% of the population and may remain silent throughout life or may present incidentally with an intra-abdominal complication. Complete patency of vitello-intestinal duct is the rarest of all the anomalies of VID. We report a case of 27 day old female presenting with pinkish umbilical mass since birth referred to us by a paediatrician as umbilical granuloma, which turned out to be patent vitello- intestinal duct.Publication Patterns and Outcome of Neonatal Intestinal Obstruction in Kanti Children’s Hospital(Nepal Paediatric Society (JNPS), 2020) Thapa, Bijay; Basnet, AnupamaAbstract: Introduction: Neonatal intestinal obstruction is the most common neonatal surgical emergency. More than 75% of neonatal surgeries are done for the correction of this problem. The outcome of this obstruction mainly depends upon the causes of obstruction, clinical condition of the patient, associated anomalies, expertise and centre where the patient is dealt. This study was undertaken to study the clinical features and outcome of neonatal intestinal obstruction presented in our centre. Methods: The medical records of all neonates admitted in the surgical NICU were selected and cases with the diagnosis of neonatal intestinal obstruction and managed surgically during two years period from September 1, 2015 to September 1, 2017 were retrospectively reviewed and analysed in regard to age at presentation, sex, weight, gestation, postoperative diagnosis and their outcome. Results: Out of 235 admitted neonates, 205 cases were treated surgically for intestinal obstruction. There were a total of 154 (75.2%) males and 51 (24.8%) females. Mean age at presentation was 4.5 days and average weight was 2.25 kg. Among them, anorectal malformation (ARM) 88 (42.92%), intestinal atresia 59 (28.78%), Hirschsprung’s disease 38 (18.53%), malrotation of gut 10 (4.87%) and meconium ileus 10 (4.87%) were the etiology. Among intestinal atresia, duodenal atresia 27 (45.76%) was the commonest one followed by ileal atresia 24 (40.67%), six jejunal atresia (10.16%) and two colonic atresia (3.38%). Overall, 160 neonates survived (78.04%). Among the survival, Hirschsprung’s disease was 34 (89.47%), ARM 78 (88.63%), seven malrotation of gut (70%), six meconium ileus (60%) and intestinal atresia 35 (59.32%). Conclusion: Neonatal intestinal obstruction is the most common neonatal surgical emergency in Kanti Children’s Hospital. Anorectal malformation was the commonest etiology followed by intestinal atresia and Hirschsprung’s disease. Overall survival rate was 78%. Cases with Hirschsprung’s disease and anorectal malformation had about 90% survival rate. Intestinal atresia was the major cause of mortality occupying 53.35% of total mortality of 21.95%. Mortality is mainly due to delayed diagnosis, referral and intervention which lead to higher complications of cases.Publication Pediatric Appendicitis Score and Ultrasound in children with Acute Appendicitis: An Observational Study(Nepal Medical Association, 2025) Simkhada, Suyog; Thapa, Bijay; Basnet, Anupama Thapa; Karki, SijanAbstract Introduction: Acute appendicitis is a common surgical emergency encountered in pediatric population. Differential diagnosis in this age group present with similar signs and symptoms. Clinical scoring system and Ultrasound imaging are helpful in diagnosing acute appendicitis and ruling out its differential diagnosis. This study was done to assess the findings of presence or absence of appendicitis in children based on the Pediatric Appendicitis Score (PAS) and ultrasound scan. Methods: An observational cross-section study was done from November 2023 to May 2024, in a tertiary level hospital, Kathmandu. All children between the ages of five and 14 years undergoing surgery for the provisional diagnosis of acute appendicitis were included in the study. The provisional diagnosis was based on a Pediatric appendicitis score and ultrasound. The diagnosis was confirmed by histopathology. Ethical approval was taken from Institutional Review Committee (Reference number: 811/2080/81). Results: A total of 50 children were included during the study period. A pediatric appendicitis score of more than seven, which is considered a high risk, was observed in 43 (86%) patients, and a score between four and six, which was considered an intermediate risk, was observed in 6 (12%) patients Similarly, 39 (78%) of the patient had appendix diameter more than six mm and 10 (20%) had less than six in ultrasound measurement. Conclusions: Both Pediatric Appendicitis Score and Ultrasonography can be used to diagnose acute appendicitis in children.