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Abstract: A 50-year-old female patient with recent symptoms of lower abdominal tension, pain, nausea, vomiting, etc. On examination and pressure, the patient developed significant pressure pain and could palpate a hard object in the abdomen, which was considered to be gynecological inflammation causing pelvic inflammatory disease throughout, further leading to peritoneal adhesions.
Basic information】Female, 50 years old
Type of disease】peritoneal adhesions
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】August 2021
Treatment plan】Surgical treatment (laparoscopic adhesions separation and cyst removal) + intravenous injection (cefazoxime sodium for injection)
Treatment period】1 week of inpatient treatment and regular outpatient follow up
Treatment effect】Wound healing was excellent, and the adhesions disappeared.
I. Initial consultation
The patient recently presented with symptoms of lower abdominal tension, pain, nausea and vomiting. Through the medical history, we learned that the patient had long been suffering from gynecological inflammation, which always recurred, and there was obvious pressure pain on examination and pressure, and hard objects could be palpated in the abdomen. The patient was told that gynecological inflammation, such as tubal inflammation, cervicitis, and endometritis, may have caused the entire pelvic inflammation, which then spread to the abdomen, forming peritonitis and further leading to peritoneal adhesions, and that imaging could be performed to understand the intra-abdominal situation. The magnetic resonance examination showed that the patient had peritoneal adhesions and a cyst in the abdomen, and was hospitalized.
II. Treatment history
Based on the findings, it was determined that the patient had peritoneal adhesions and a cyst in the abdominal cavity, which required surgical treatment to separate the adhesions and remove the cyst. Laparoscopic surgery was preferred, which is less invasive and has faster recovery. The patient took my treatment plan and the surgery was scheduled. The laparoscopic surgery consisted of three perforations in the abdomen for the placement of laparoscopic instruments to explore the abdominal cavity, followed by dissection of the adhesions using surgical forceps and removal of the cysts in the abdominal cavity to avoid later lesions, followed by hemostasis, placement of drains, and suturing of the incisions. After laparoscopic surgery, cefazoxime sodium for injection was given intravenously to play the role of anti-infection treatment.
III. Treatment effect
After 1 week of hospitalization, the patient indicated that the pain and discomfort in the lower abdomen, nausea and vomiting disappeared, and the surgical incision healed well without infection, blood leakage and other adverse phenomena, so the patient was discharged home to recuperate. One week after discharge, the patient came for a follow-up examination and the wound healed well, so the stitches were removed and the symptoms of peritoneal adhesions were completely eliminated on imaging, and the symptoms of gynecological inflammation were also relieved.
IV. Notes
We are glad that after surgical treatment, the patient’s peritoneal adhesions were completely eliminated and her gynecological inflammation was relieved. However, it is still necessary to advise the patient to avoid bending, lifting heavy objects, strenuous exercise and violent coughing until the abdominal incision is completely healed after discharge, so as not to affect the wound healing. The postoperative diet should be light and easy to digest. You can eat easy-to-digest foods such as millet porridge, rice porridge, milk powder, etc. Avoid spicy and irritating foods and cold foods to avoid causing irritation to the intestines and causing diarrhea and other uncomfortable symptoms. In addition, pay close attention to the incision and seek medical attention in case of bleeding, pus, swelling, pain and other discomforts to avoid wound infection and re-adhesion of the wound.
V. Personal insight
Peritoneal adhesions are mainly caused by inflammation and incisional infection, as in the case of this patient who had long-standing gynecological inflammation but was not treated in time, the inflammation was involved in the abdomen, forming peritonitis and then peritoneal adhesions occurred. Therefore, women should pay attention to the fact that gynecological inflammation should be seen in a timely manner, standardized treatment, and the vulva area should be kept clean and hygienic in general to avoid infection.
In addition, active prevention and treatment of primary diseases, such as gallbladder stones, gastric disease, appendicitis, cholecystitis, etc., can effectively prevent the occurrence of peritoneal adhesions.