Phytobezoar: A Rare Cause of Small Bowel Obstruction

Introduction: Small bowel obstruction is a common condition encountered in surgical practice. However, obstruction due to phytobezoars is a rarity. Until recently, phytobezoars were incidental findings during surgery however advances in imaging have eased the diagnosis by precisely identifying and locating the etiology. Case: An 86-year-old lady presented to the emergency room with abdominal pain, distension, and inability to pass stool and flatus. Workup showed she had features of small bowel obstruction with features of sepsis with worsening of preexisting respiratory co-morbidity. Exploration showed a phytobezoar causing the bowel obstruction. Conclusion: Phytobezoar though uncommon should always be thought of while treating a case of intestinal obstruction in the elderly age group. Surgery is the mainstay of treatment. However preexisting co-morbid condition plays a vital role in the outcome

Adenomyoma As A Lead Point For Jejunal Intussusception In An Adult: A Rare Case

Adenomyoma of small intestine causing intussusception in adults is a rare condition. The small intestine is the second most frequent location, usually in the periampullary area, but the lesion also occurs in the jejunum and ileum.We present a case of 76 years old female who presented with pain abdomen and was diagnosed to have jejunal intussusception. She underwent surgery with segmental resection and anastomosis of jejunum and the histopathological examination revealed jejunal adenomyoma as the pathological lead point. Adenomyoma of jejunum as a lead point should be taken into consideration while dealing with a patient with jejunal intussusception

Endoscopic findings of acid peptic disease at low and high altitude: Kathmandu versus Rasuwa districts of Nepal: Endoscopic findings of APD at low and high altitude

  Introduction: Features of Acid Peptic Disease (APD) have specific presentations from low to high altitudes. This study aims to compare the endoscopy findings of APD at low altitudes (Kathmandu Valley) and High Altitudes (Rasuwa District) of Nepal.   Method: Endoscopy findings of APD patients from Nov 2017 to Dec 2021 at Manmohan Medical College and Teaching Hospital (MMTH) were reviewed from the data kept in the endoscopy unit to compare the findings among patients from low altitudes (Kathmandu valley) and high altitudes (Rasuwa district). Variables included were age, sex, and endoscopy findings of APD. Microsoft Excel was used for data analysis. Chi-square analysis was used for the association between APD findings and altitude. A p-value ≤0.05 was considered statistically significant.   Result: Out of 2937 APD patients, 1560 (53.1%) were male and 1377(46.9%) female, age 48.5 years (range 16-81) with 2701(91.6%) having endoscopic findings of APD. Among 2701 APDs, 1448 (88.6%) were from the low altitude of Kathmandu valley, and 1253 (96.2%) were from high altitude (Rasuwa district), p-value <0.0002. There were 736(50.8%) patients with gastritis from Kathmandu vs. 695 (55.46%) from Rasuwa, followed by gastro-duodenitis 219(15.1%) vs. 32 (2.5%), duodenitis 171 (11.8%) vs. 169(13.5%) respectively.   Conclusion: The incidence of endoscopic findings of overall APD was high among patients from the high altitude of Rasuwa district compared to the low altitude Kathmandu valley of Nepal.   Keywords: acid Peptic Disease (APD), endoscopy, high altitude, Kathmandu valley, Rasuwa district, Nepal

Net Zero Stocktake 2023

The underlying dataset for the Net Zero Tracker's Net Zero Stocktake Report 2023