Fecalith is a concretion of dry compact feces or hard stony mass of faeces in the intestinal tract. Thoughappendicular fecoliths are commonly encountered, caecal fecoliths are rare entities. Fecoliths areamenable to conservative management with laxatives and enemas but surgical management preventsrecurrence. We present a case of 27 years old male who was diagnosed with acute appendicitis withperitonitis. He was intraoperatively diagnosed as gangrenous and perforated retrocaecal appendixwith multiple small fecaliths and a large fecalith on cecum with perforation. Appendectomy andprimary repair of caecal perforation done. Histological examination of perforated margin confirmedas an inflammatory lesion.
Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them against severe illness.
In present scenario, nephrolithiasis (renal stones) are more prevalent and highly related with morbidity worldwide. The aim of the study is to associate different biochemical and hemodynamic parameters of renal stones and to see post-operative outcomes. Hundred patients from January 2019 to January 2021 having renal stone in ultrasonography at Shahid Dharmbhakta National Transplant Centre Bhaktapur are included in the study. All variables are measured following the standard protocol. Nephrolithiasis was found to be frequent in male population (60%) who has a habit of regular alcohol intake (65%, p=0.009) and mixed dietary habit (mostly non-vegetarians) (92%, p= 0.042). Calcium oxalate either solely (21%) or mixed type (41%) were higher in proportion. The most common dyslipidemia in recurrent cases were hypercholesterolemia and increased LDL (p<0.001). The significant increase in serum urea (p=0.006) and creatinine (p=0.004) signify decrease in eGFR (p=0.007). Serum creatinine with IQR (1-2.5 mg/dl) was noticed significantly higher in others stone group V in contrast to mixed calcium containing stones group IV. Hydronephrosis was seen in 96% of patient, 7% developed post-operative complication comprising 57% haematuria, 28.5% wound infection and 14.5 % chest infection. Biochemical and hemodynamic parameters should be incorporated in nephrolithiasis to rule out risk of dyslipidemia, chronic kidney disorder and stratify the risk group based on stone composition.
Eosinophilic ureteritis is a rare cause of ureteric stricture causing hydroureteronephrosis. The exact aetiology of this condition is still unknown. This condition has been described in relation to atopy, hypereosinophilic syndrome and prior ureteral interventions. The histopathology is the conclusive diagnostic modality. The surgical resection of the ureteric stricture part with end-to-end anastomosis is usually successful. Herein, we report a case of a 19-year-old woman, who presented with right flank pain. With imaging and diagnostic ureteroscopy, the case was diagnosed as eosinophilic ureteritis. The case was successfully managed with resection of the stenosing part and end-to-end anastomosis. No cases of the disease have been reported until now in Nepal.
Background. Large urinary bladder stones are not common and even less common in females. We report a case of large bladder stone presented with acute retention of urine in a female patient. Case Report. A 62-year-old female presented in emergency department with retention of urine for 12 hours with history of recurrent UTIs for last 1 year. She was also complaining of mild dull lower abdominal pain for last 6 months. She had no history of incontinence of urine and fever. On physical examination, hard mass was palpable on suprapubic region on palpation of abdomen. Urine culture shows Escherichia coli for which antibiotics was given. An X-ray kidney ureter bladder showed a radio-opacity in the pelvic region measuring 9 × 8 cm in size. Ultrasonography revealed bilateral mild hydronephrosis with a large bladder stone. Open cystolithotomy was performed, and the stone was taken out. Stone biochemical analysis showed predominantly urate crystals. Patient had uneventful postoperative course, and she was discharged on 4th postoperative day and was followed up for 1 months after operation. Conclusions. Large urinary bladder stones are not common and even less common in females. Clinician should have think regarding large bladder stone as a cause of recurrent lower urinary tract symptoms like dysuria and should assess renal function for proper treatment. Open cystolithotomy is choice of operation in large bladder stone.
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