Intrahepatic pancreatic pseudocyst (wayward cyst): A rare presentation of traumatic pancreatitis.

INTRODUCTION: Cystic lesions in the liver are commonly encountered space-occupying lesions having various etiologies such as simple cysts, malignancies, hydatid cysts, and pancreatic pseudocysts. CASE PRESENTATION: An eight-year-old girl initially presented with acute abdominal pain, fever, and a cystic lesion in the upper abdomen. Surgical intervention was performed based on an initial diagnosis of an inflammatory cyst. Later, she developed pleural effusion. Further investigations, unveiled a cystic mass arising from the head of the pancreas, and a pancreatico-pleural fistula. Retrospective analysis revealed a history of trauma that started her illness course. Conservative management involving intercostal tube drainage and octreotide infusion resulted in a favorable outcome. DISCUSSION: Pancreatic pseudocyst is typically results from pancreatitis or trauma but in rare cases, they can have extended to unusual locations such as the liver. This case highlights the varied presentations and complex interplay of symptoms associated with intrahepatic pseudocysts. The initial oversight of trauma in the patient's history underscore the importance of thorough history-taking for an accurate diagnosis. The complexity of this case emphasize the necessity of a multidisciplinary approach in managing such atypical presentations. CONCLUSION: Intrahepatic pseudocysts, especially those resulting from post-traumatic pancreatic pseudocyst, are uncommon and are not typically included in the differential diagnosis of liver lesions. This case highlights the significance of identifying unusual presentation and thoroughly investigating the patient's medical history to make an accurate diagnosis. A multidisciplinary approach is essential for effective patient management in these complex cases.

An ischemic complication of a snake bite: Case report.

INTRODUCTION AND IMPORTANCE: Snakebite is a common type of animal bite injury worldwide. The local effect can manifest as an abscess followed by cellulitis and compartment syndrome which could cause ischemic tissue damage. CASE PRESENTATION: A case of a 40-year male with a history of a snake bite 4 days back complained of swelling, throbbing pain, bluish discoloration of the skin and blackish discoloration of the little finger. Incision and drainage were done initially with disarticulation of the gangrenous little finger and finally treated with a split-thickness graft. CLINICAL DISCUSSION: Snakebite can lead to only the bite mark without clinical features, local manifestations around the bite site, systemic toxicity due to redistribution of venom and signs and symptoms due to traditional treatment. Delayed presentation and improper treatment can lead to wound infection, abscess, compartment syndrome, necrotizing fasciitis and gangrene. CONCLUSION: Snakebite is common in rural areas around the tropical world. Complications like compartment syndrome, necrotizing fasciitis and gangrene could develop following snake bite for which immediate surgical intervention is required to prevent loss of limb and life.

Guillain-Barré syndrome associated with Coronavirus disease 2019: A case from Nepal.

Coronavirus disease 2019 (COVID-19) has now spread widely after the outbreak since December 31, 2019. Guillain-Barré syndrome is an immunological postinfectious neuropathy, which has been reported to be a rare but possible complication COVID-19. We report a case of Guillain-Barré syndrome associated with COVID-19 in Nepal.