Tribhuvan University Teaching Hospital is well known public hospital in Nepal. This was established in 1982. Initially it had 300 bed facility which is now increased and now it has 700 bed facility.this hospital is the site of Under Tribhuvan University teaching and research activities for Institute of Medicine..
Introduction and importance:Ovarian ectopic pregnancy (OEP) is a rare but serious condition, accounting for only 0.5-3% of all ectopic pregnancies. Because it is so uncommon and its symptoms often mimic other conditions, diagnosing OEP can be incredibly difficult. Presentation of case:This case report follows a 24-year-old woman, pregnant for the first time, who arrived at the hospital with abdominal pain and vaginal bleeding. Surprisingly, she had none of the typical risk factors associated with ectopic pregnancies. Initially, her condition was misdiagnosed until an ultrasound revealed a gestational sac in her adnexa. She underwent emergency laparotomy, which confirmed a ruptured OEP. Surgeons performed an ovarian wedge resection, and the diagnosis was later confirmed by histopathology. Clinical discussion:This case highlights how crucial early detection and surgical intervention are in OEP, especially in settings with limited medical resources. It also reinforces that any woman of reproductive age with sudden abdominal pain and bleeding should be evaluated for OEP, even if she has no known risk factors. Conclusion:Timely treatment and histopathological verification are essential to prevent complications and protect future fertility. This case also highlights the need for heightened awareness, rapid imaging, and decisive surgical action even when symptoms do not follow the usual pattern. Given that few documented cases exist, particularly in low-resource environments, this report adds valuable insights into the diagnosis and management of OEP.
Introduction:Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with 25-30% arising from the small intestine. While GISTs commonly present with abdominal pain or gastrointestinal bleeding, they may rarely manifest as acute surgical emergencies such as small bowel volvulus (SBV). Presentation with diffuse metastatic disease, including umbilical involvement (Sister Mary Joseph's nodule), at initial diagnosis is exceptionally uncommon. Case presentation:A 60-year-old woman presented with acute abdominal pain, vomiting, and obstipation for 2 days. Clinical examination revealed a soft, non-tender, distended abdomen with preserved bowel sounds. Imaging revealed small bowel obstruction with the characteristic whirlpool sign, a pelvic mass, diffuse peritoneal deposits, a Sister Mary Joseph's nodule, and a hepatic lesion. Emergency laparotomy revealed a 13.0 × 7.5 × 6.5 cm jejunal mesenteric mass causing a 180° anticlockwise volvulus with widespread peritoneal, omental, and umbilical nodules. Segmental jejunal resection with jejunojejunal anastomosis was performed for symptom palliation. Histopathology confirmed spindle-cell GIST, positive for CD117 and DOG1, with a mitotic count of 1/5 mm2 and a Ki-67 index of 3%. The tumor was staged as pT4 Nx M1 and categorized as high-risk. The patient recovered uneventfully and was started on treatment with imatinib mesylate. Clinical discussion:SBV secondary to GIST is rare and typically occurs in the presence of large extramural tumors that act as a lead point for mesenteric rotation. This case highlights the insidious biological behavior of GISTs, wherein prolonged asymptomatic growth may culminate in advanced metastatic disease at presentation, despite low proliferative indices. The presence of Sister Mary Joseph's nodule further signifies advanced intra-abdominal dissemination and poor prognostic implications. Conclusion:GISTs should be considered in cases of unexplained SBV. This case emphasizes the diagnostic challenges, the need for prompt surgical palliation, and the role of systemic tyrosine kinase inhibitors in advanced presentation of GIST.
Background:Postoperative central diabetes insipidus (CDI) is a well-documented but often transient complication following transsphenoidal surgery (TSS) for pituitary adenomas. CDI is characterized by excessive urine output due to impaired antidiuretic hormone (ADH) secretion following damage to the neurohypophyseal stalk or hypothalamus. While most cases resolve within a few days, severe cases with extremely high urine output are rare. This case is notable due to an exceptionally high urine output of 33.5 L in a single day, far exceeding typical postoperative presentations and highlighting the need for vigilant postoperative monitoring. Case Presentation:A 47-year-old female with hypertension and hypothyroidism underwent endoscopic endonasal TSS at Tribhuvan University Teaching Hospital (TUTH) for a pituitary macroadenoma compressing the optic chiasm. Within hours postoperatively, she developed significant polyuria exceeding 1000 mL/h, with urine osmolality of 213.3 mOsm/kg and hypernatremia (serum sodium 149 mmol/L), consistent with CDI. Urine output increased to 30.8 L on postoperative day 2 and peaked at 33.5 L on day 3, requiring aggressive fluid replacement and desmopressin therapy. Despite escalating doses of desmopressin, polyuria persisted before gradually resolving by postoperative day 5. Careful monitoring of electrolytes and stepwise adjustment of desmopressin led to stabilization, confirming transient rather than permanent CDI. Conclusion:This case highlights that postoperative CDI can present with extreme polyuria and rapid shifts in sodium and osmolality, making early recognition essential. It reinforces that individualized desmopressin titration and close fluid-electrolyte monitoring are critical to prevent complications and support full recovery, especially when urine output reaches unusually high levels.
Introduction:Acute abdomen refers to sudden, spontaneous, non-traumatic abdominal pain of less than a week. It is one of the common causes of emergency room visits and abdominal surgery. Therefore, it is critical for healthcare professionals to be familiar with the presentations of the common causes of acute abdomen, as well as the strength and validity of the investigative tools. Methodology:In this hospital-based observational study (September 2023 to August 2024), a total of 81 patients with acute abdomen who underwent emergency surgery were enrolled. Data were collected using a proforma, and statistical analysis was performed using IBM SPSS v28 (P value < 0.05 considered significant). Results:Among 81 patients included in this study, acute abdomen was most common in males and the 16-25-year age group. Common symptoms of acute abdomen were abdominal pain, nausea/vomiting, anorexia, constipation/obstipation, and fever, while common signs were tenderness, rebound tenderness, guarding/rigidity, tachycardia, and abdominal distention. The most common postoperative diagnosis was acute appendicitis (33.33%), and including its sequelae, it accounted for 51.85%. The next most common pathologies were perforation peritonitis (22.2%) and bowel obstruction (21%). Ultrasonography (USG) was the most specific tool in the diagnosis of appendicular pathologies (Sn = 73.81%, Sp = 96.87%, and accuracy = 83.78%). In cases of perforation peritonitis, clinical signs of generalized peritonitis were an equally effective method, with sensitivity comparable to an X-ray. The most sensitive tool in bowel obstruction was plain abdominal X-ray (sensitivity [Sn] = 88.24%), while USG had the highest specificity (Sp) of 94.74%. The diagnostic accuracy of acute abdomen was 88.89%, and the negative laparotomy rate was nil. Conclusion:This study highlights the critical nature of accurate preoperative diagnosis in acute abdomen cases and the potential for improved patient outcomes through enhanced investigative strategies. For better outcomes in patients with acute abdomen, early diagnosis based on clinical findings, supported by laboratory and radiological correlation, followed by timely decision-making regarding operative management, is of utmost importance.
ABSTRACT The colon single stripe sign (CSSS) is associated with ischemic‐pattern colonic injury. We report a 69‐year‐old woman with norovirus infection, hematochezia, recurrent left‐sided colitis, and chronic NSAID use found to have CSSS on colonoscopy, suggesting a multifactorial “two‐hit” mechanism involving NSAID‐related mucosal vulnerability and transient hypoperfusion.
