Nepal: Kanti Childrens Hospital

Nirjala KC

Diaphragmatic Hernia

2-year-old girl Nirjala KC was referred to the Surgical department from the Medical department on May 31, 2019, after the incidental finding of a right diaphragmatic hernia on a USG. She was admitted to the Medical department with diagnosis of pneumonia, and once the pneumonia was resolved, she was referred to the Surgical department for the management of the right diaphragmatic hernia. The CT scan of chest was done, and the report confirmed a right posterolateral diaphragmatic hernia.

Nirjala was scheduled for surgery. All the baseline preoperative investigations, including an echocardiogram, were sent. After all the investigations results came back, normal and the patient was deemed fit for operation, the surgery was performed on June 2, 2019. The surgery was successful, and Nirjala was transferred to the Surgical ICU, where she remained for 3 days. As the postoperative days were uneventful, and the patient was improving and was stable, she was transferred to the Surgical ward. There, she was kept for 2 more days under observation. On the 6th postoperative day, June 8, 2019, Nirjala was discharged with oral medications.

The patient’s parents were very happy about the successful surgery their daughter underwent in our hospital and were thankful to entire surgical team.

Srijana Lama

Bladder Exstrophy

Srijana Lama’s 2-day-old baby daughter was brought to Kanti Children’s Hospital’s Emergency department on April 10, 2019, with a reddish mass protruding from her abdomen below the umbilical region. After an examination, the baby was diagnosed with bladder exstrophy. She was in stable condition, and all baseline investigations, including a pelvic x-ray and an ultrasonography, were done, after which she was admitted to the Surgical ICU.

All of the investigation results were within the normal ranges. The USG confirmed that the baby was a female, as the genitalia of the baby was not differentiated initially. The surgery was planned, but surgeries for bladder exstrophy require an orthopedic surgeon, as the pelvic bones must be separated. Since the orthopedic department was not available in our hospital, an orthopedic surgeon from another center was called, and the surgery was scheduled for April 24, 2019.

All the preoperative preparations were done, and blood was arranged in case it was required intraoperatively. The surgery started around 10:00 AM and ended at around 4:00 PM. The surgical repair of bladder exstrophy with osteotomy was a success, and the baby was transferred back to the Surgical ICU. Her postoperative days were uneventful; the baby was stable with a hip spica cast on. On the 6th postoperative day, April 30, 2019, the baby was transferred from the ICU to the Surgical ward, as her condition was stable, and she had started breastfeeding. After 2 weeks, the hip spica was removed, and after 3 weeks, the catheters were removed.

As the baby was healthy, she was discharged on May 16, 2019, after 38 days at the hospital. The parents were happy about the successful surgery their baby underwent, and thankful to all the teams.

Rinkika Baral

Appendicular Lump

Rinika Baral is an 8-year-old girl who was brought in to the Emergency department with abdominal pain for 5-6 days, 2 episodes of vomiting, and an on-and-off fever. Her bladder and bowel movements were normal. On examination, the clinicians found tenderness over the right iliac fossa and umbilical region. Rinika’s stomach was soft and not distended, and on deep palpation, a mass was felt measuring approximately 2×2 cm.

All blood investigations were within normal limits, except white blood cell count, which was raised above normal levels. An abdominal USG was done, showing an appendicular lump. Conservative management was done, with antibiotic therapy for 5 days, and later she was discharged and advised for an elective appendectomy after 6-8 weeks.