Incidental finding of Poland syndrome in a case of phimosis: a rare case report from Nepal.

Poland syndrome is a rare congenital syndrome that mostly includes the absence of unilateral pectoralis major muscle and digit anomalies like symbrachydactyly. It can also present with other varied manifestations like the absence of ribs, bilateral absence of pectoralis major muscle, urogenital anomalies, dextrocardia, etc. Case Presentation: We herein present a case of a 6-year-old boy with Poland syndrome as an incidental finding, the second one reported from Nepal, 11 years after the first report. The syndrome was diagnosed after the patient came to the hospital for treatment of phimosis. On examination, the sternocostal head of the right pectoralis major muscle was absent with a palpable clavicular head with symbrachydactyly of the ipsilateral side. Discussion: Poland syndrome is mostly diagnosed clinically. Its differential diagnosis includes other chest wall anomalies, nipple anomalies, isolated thoracic lipoatrophy, and isolated hand/upper limb anomalies without pectoralis major muscle involvement. Computed tomography and MRI scans can help delineate the exact chest wall abnormality. It also helps to find other manifestations of the syndrome and for the treatment plans. Conclusion: Poland syndrome is a rare syndrome that has the propensity to be missed in clinical settings. Treatment, mainly sought for cosmetic reasons, includes breast augmentation procedures or myocutaneous flap coverage.

Hernia among Patients Admitted to the Department of Surgery of a Tertiary Care Centre.

Introduction: Hernia is one of the most common surgical conditions causing disability and requiring hospital admission and surgery. The aim of this study was to find out the prevalence of hernia among patients admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery between 14 April 2021 and 13 April 2023 and were collected from 1 July 2023 to 31 July 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee. The patient admitted to the Department of Surgery was included and those with incomplete data were excluded. Convenience sampling was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 2057 patients, the prevalence of hernia was 247 (12.01%) (10.61-13.41, 95% Confidence Interval). A total of 31 (12.55%) hernias were irreducible and 15 (6.07%) were operated in the emergency setting. The most common type of hernia was inguinal hernia found in 169 (68.42%) and hypertension was the most common comorbidities found in 48 (19.43%). Conclusions: The prevalence of hernia was similar to other studies done in similar settings. Hernia accounts for a major surgical burden in our setting. So, early diagnosis and treatment could reduce the morbidity and mortality related to it. Keywords: hernia; inguinal hernia; prevalence; surgery; umbilical hernia.

Intestinal Perforation with Ingestion of Blunt Foreign Bodies: A Case Report.

Foreign body ingestions are fairly common and present with obvious symptoms. Certain foreign bodies, like button batteries and magnets, are rarely ingested, but carry with them the extremely dangerous risk of bowel wall necrosis, intestinal perforation and fistula formation. Suspected cases of such ingestions require a high index of suspicion and any delay should be avoided once a diagnosis is made. Herein, we report a case of a 7-year-male patient who presented with abdominal pain and vomiting following similar foreign body ingestion, which resulted in multiple small bowel perforations. The foreign body was removed by a laparotomy, and the affected bowel segments were resected and anastomosed. The patient made an uneventful recovery and was discharged after 5 days.

Support for Introduction of Pediatric Endosurgery in Nepal as Global Pediatric Surgery: Preliminary Needs Assessment Survey.

Background: Endosurgery provides several advantages over open surgery in the context of global surgery; however, there are several barriers to its introduction. The preliminary assessment of needs and barriers is essential for carrying out effective support as Global Surgery. However, no report has described the initiation of support for endosurgery based on a preliminary survey of the needs and barriers. The present survey study aimed at determining the needs and barriers of pediatric endosurgery in Nepal. Materials and Methods: A needs assessment survey was conducted among all pediatric surgeons in Nepal via an online platform. This was followed by workshop on pediatric endosurgical skills in Nepal. To assess the skills of participants and effectiveness of the workshop, the skill evaluation tests and the questionnaire survey were conducted. Results: Fourteen pediatric surgeons (response rate: 60.9%) responded to the needs assessment survey. More than 70% of the participants did not have any experience with advanced endosurgical procedures. However, advanced endosurgical procedures were strongly needed. A lack of training was indicated as a major barrier for the introduction of pediatric endosurgery. Fifteen participants completed the workshop. Participants' confidence in their endosurgical skills improved significantly after the workshop. The skill evaluation tests revealed that participants' endosurgical skills also improved significantly after the workshop, although even after the workshop, participants still took an average of 415.6 seconds to place and knot one suture. Conclusions: The needs assessment survey and workshop for Nepalese pediatric surgeons helped clarify their needs for endosurgery and the barriers to its introduction.

Compliance of WHO Surgical Safety Checklist at a Pediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal. METHODS: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25.Point estimate at 95% Confidence Interval was done along with frequency and proportion for binary data. RESULTS: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete. CONCLUSIONS: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.