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Papers by anup shrestha

Research paper thumbnail of Diagnosis and Management of Gallbladder Perforation: A Single-Center Experience

Journal of Chitwan Medical College

Background: Gall bladder perforation is one of the uncommon serious complications of cholelithias... more Background: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation. Methods: This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated. Results: A total of 24 pa...

Research paper thumbnail of Additional file 1 of Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

Additional file 1. Supplementary Table.

Research paper thumbnail of A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Med Phoenix, 2021

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is ... more Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.

Research paper thumbnail of Surgical outcome of superior mesenteric artery-first approach with radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer

Research paper thumbnail of Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

International Journal of Emergency Medicine

Background The liver is the second most injured organ following blunt abdominal trauma (BAT) afte... more Background The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), t...

Research paper thumbnail of Preoperative Neutrophil to Lymphocyte Ratio as a Predictor of the Severity of Acute Appendicitis

Journal of Chitwan Medical College, 2021

Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cate... more Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cated and uncomplicated acute appendicitis (AA) preoperatively. However there is a consid­erable difference in the cutoff values of NLR in different studies. This study aimed to establish a cutoff value of NLR to distinguish complicated AA from uncomplicated AA preoperatively at our center. Methods: This was a prospective observational study conducted over 2 years from January 2017 to December 2019 in the department of surgery, Chitwan Medical College Bharatpur. Patients with a provisional diagnosis of AA and undergoing appendectomy were included in the study. The difference in NLR between the two groups was compared by Mann-Whitney U-test. The predictive ability of NLR was estimated by the receiver operating characteristic (ROC) curve analysis. Results: One hundred eighty-eight patients were included in the study, 112 patients were males and 76 were females. Among them, 29.2% (n=55) were co...

Research paper thumbnail of Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature

Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the commo... more Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones,...

Research paper thumbnail of A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Med Phoenix, 2021

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is ... more Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.

Research paper thumbnail of Diagnosis and Management of Gallbladder Perforation: A Single-Center Experience

Journal of Chitwan Medical College

Background: Gall bladder perforation is one of the uncommon serious complications of cholelithias... more Background: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation. Methods: This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated. Results: A total of 24 pa...

Research paper thumbnail of Additional file 1 of Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

Additional file 1. Supplementary Table.

Research paper thumbnail of A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Med Phoenix, 2021

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is ... more Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.

Research paper thumbnail of Surgical outcome of superior mesenteric artery-first approach with radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer

Research paper thumbnail of Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

International Journal of Emergency Medicine

Background The liver is the second most injured organ following blunt abdominal trauma (BAT) afte... more Background The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), t...

Research paper thumbnail of Preoperative Neutrophil to Lymphocyte Ratio as a Predictor of the Severity of Acute Appendicitis

Journal of Chitwan Medical College, 2021

Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cate... more Background: Neutrophil to lymphocyte ratio (NLR) is one of the tools to differentiate compli­cated and uncomplicated acute appendicitis (AA) preoperatively. However there is a consid­erable difference in the cutoff values of NLR in different studies. This study aimed to establish a cutoff value of NLR to distinguish complicated AA from uncomplicated AA preoperatively at our center. Methods: This was a prospective observational study conducted over 2 years from January 2017 to December 2019 in the department of surgery, Chitwan Medical College Bharatpur. Patients with a provisional diagnosis of AA and undergoing appendectomy were included in the study. The difference in NLR between the two groups was compared by Mann-Whitney U-test. The predictive ability of NLR was estimated by the receiver operating characteristic (ROC) curve analysis. Results: One hundred eighty-eight patients were included in the study, 112 patients were males and 76 were females. Among them, 29.2% (n=55) were co...

Research paper thumbnail of Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature

Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the commo... more Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones,...

Research paper thumbnail of A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Med Phoenix, 2021

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is ... more Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.