Median nerve schwannoma with a diagnostic delay of 8 years: a case report.

Introduction: Schwannomas are benign tumors of the peripheral nerve sheath, and the median nerve is the most commonly involved nerve. These benign tumors of the peripheral nerve sheath are very rare; they are clinically and radiologically similar to most other benign swellings of the hand; thus, they are often misdiagnosed. Case Presentation: A 41-year-old lady presented with an 8-year-long history of swelling over the distal forearm. The tumor measured 3.5×3.5×3.5 mm and was located over the flexor aspect of the distal part of her right forearm. Schwannoma was suspected from the clinical presentation and imaging, but the final diagnosis was established only after the surgery and histopathological analysis. At the follow-up after 1 year, the patient is doing well and her symptoms have not recurred. Conclusion: Imaging characteristics of schwannoma can be misinterpreted as some other condition, making the preoperative diagnosis very difficult and important. Thus, clinicians should be aware of such swellings, especially those that have been unnoticed or misdiagnosed, and provide optimal diagnoses to confer good outcomes.

Chronic lymphedema reversal following arteriovenous fistula takedown: A case report.

INTRODUCTION AND IMPORTANCE: Lymphedema is a very rare complication of Arteriovenous Fistula. The commonly encountered complications following the arteriovenous fistula are thrombosis, stenosis, congestive heart failure, ischemic neuropathy, steal syndrome, aneurysm and infection. Hence, presence of Lymphedema is a rarity that must be managed vigilantly. The incidence of lymphedema following AV fistula is very rare. Presently there is lack of studies evaluating the outcome of fistula take down. The standard care for lymphedema is complex decongestive physiotherapy in most of other causes bur Fistula Take down also helps in reducing the swelling in our case. CASE PRESENTATION: Our case is of 53 years female presented to the surgical OPD with left upper limb swelling 5 months back which was non-pitting in nature. She was a known case of Acute kidney injury with no history of other comorbidities. The swelling started about 1 year ago involving the upper parts of the left arm which was intermittent and relieved spontaneously. She has a history of brachiocephalic fistula insertion for hemodialysis access 4 years ago with diagnosis of Acute Kidney Injury. However, the fistula was never used because of patient recovering from medical management. Investigations performed were doppler and other routine tests. CLINICAL DISCUSSION: The fistula was patent on examination confirmed by venous hum on auscultation. Fistula takedown surgery was planned after ruling out thrombosis and stenosis using doppler. Other alternatives were not considered because of lack of use of fistula. The swelling started to improve postoperatively and the patient was discharged. CONCLUSION: Our Case report highlights the fact that the rare complication like lymphedema could occur after the arteriovenous fistula which could be managed by fistula take down surgery if the fistula is no longer in use. Though very rare lymphedema should be kept in differential for complication which can be diagnosed by examination and ruling out other causes.

Resectability and prognosis of gallbladder cancer: a cross-sectional study of 100 cases from a tertiary care centre of Eastern Nepal.

Gallbladder cancer (GBC) is the fifth most common neoplasm of the digestive tract and has an overall incidence of 3 per 100 000 people. Only 15-47% of the preoperatively known GBC are suitable for resection. The objective of the study was to investigate the resectability and prognosis of GBC patients. Materials and methods: It is a prospective observational study including all cases of primary cancers of the gallbladder in the Department of Surgical Gastroenterology at a tertiary care center over the period from January 2014 to December 2019. The primary endpoint was resectability and overall survival. Results: During the study period, 100 patients with GBC were reported. The mean age at the time of diagnosis was 52.5 years, with a female predominance (67%). The curative intent resection (radical cholecystectomy) was possible in 30 (30%) patients; while 18 (18%) required palliative surgical treatment. The overall survival of the entire group was 9 months; while those patients who underwent surgery with curative intent had a median overall survival of 28 months after a median follow-up of 42 months. Conclusion: This study found that only one-third of patients achieve radical surgery with curative intent. Overall, the prognosis of patients is poor with a median survival of less than a year due to the advanced stage disease. Multimodality treatment, screening ultrasound, and neo-/adjuvant therapy may improve survival.

Foreign body-related oesophageal perforation: a case series at a community-based hospital in Nepal.

Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and high mortality rate (36%). Early diagnosis and treatment are crucial for a good outcome. Treatment is by non-operative methods (antibiotics, drainage of collections, oesophageal stenting and nutritional support) or by surgery, depending on the condition of the patient, timing of presentation and expertise. During a five-year period (2015-2019), we managed seven cases of oesophageal perforation due to a foreign body. Of them, 4 (57%) received operative intervention, while 3 (43%) were managed non-operatively. One postoperative mortality ensued; there was a mean hospital stay of 20 days.

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal.

The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.