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Abstract: A 38-year-old female patient presented to our hospital with an ultrasound suggestive of a gallbladder bulge-like lesion on physical examination because she was concerned about its pathology. After communicating with the patient and examining her, she was suspected of having a malignant tendency and was admitted to the hospital for enhanced CT of the abdomen, which showed an enhanced nodule in the gallbladder wall, laparoscopic cholecystectomy was recommended, and pathological examination was performed, which resulted in adenomatous polyps of the gallbladder, and postoperative symptomatic treatment was given.
Basic information】Female, 38 years old
Disease Type】Gallbladder adenomatous polyp
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic cholecystectomy)
Treatment Period】5 days in hospital
Results】The operation was successful, the gallbladder was completely removed, the patient had no significant discomfort, and was discharged 3 days after the operation.
I. Initial consultation
One day in March 2022, I was sitting in the clinic normally when a female patient came with an ultrasound checklist from another hospital and asked, “Doctor, I have a bulge-like lesion on my gallbladder, is there something wrong with me? “I received the ultrasound sheet and found that the gallbladder was normal in size, with a smooth wall thickness of 2 mm and an echogenic nodule of 14*16 mm with no acoustic shadow and no movement on the bottom wall of the gallbladder. The findings suggested: gallbladder augmentation-like lesion, and further examination was recommended. At this point, I started to ask the patient about his general condition. The patient was found to have gallbladder lesions on physical examination and had about six months until today, with no abdominal discomfort, no acid reflux or heartburn, no nausea or vomiting, no chills and high fever, and no yellow staining of skin mucosa and sclera in six months. After communication, the patient was suggested to be hospitalized for further examination and surgical treatment, and the patient agreed to the surgical treatment and went through the hospitalization procedure.
II. Treatment process
After the patient was admitted to the hospital, the relevant examinations were completed, and the blood routine, coagulation function, liver function, kidney function and tumor markers were basically normal. The chest X-ray and electrocardiogram were not significantly abnormal. In order to further clarify the bulge-like lesion at the base of gallbladder, the patient underwent abdominal enhancement CT, which showed an enhanced nodule at the base wall of gallbladder, diagnosed as an occupying gallbladder lesion, and recommended surgery. After active preoperative preparation, laparoscopic cholecystectomy was performed under the consultation of anesthesiology department, and the postoperative pathological findings were adenomatous polyps with severe heterogeneous hyperplasia (of the gallbladder), with no clear infiltrative changes, and a clear diagnosis of adenomatous polyps of the gallbladder.
III. Treatment effect
On the first day after surgery, the patient occasionally felt pain in the incision. I told the patient that the incision pain was normal, and that the patient needed to fast from water, glucose saline rehydration, omeprazole acid suppression, cefixime anti-inflammatory and other symptomatic support treatment. On the second day after surgery, the patient’s incisional pain was significantly relieved, and the patient was advised to move to the ground, adjust the patient’s diet, and observe. On the third day after surgery, the patient’s condition improved significantly. The patient and his family requested to be discharged, and I informed the patient of the precautions to be taken after discharge as well as the pathological results, and the patient was discharged in good condition.
IV. Precautions
I am glad that the patient was treated promptly. After the patient was discharged from the hospital, attention should be paid to keep the abdominal incision dressing dry and promptly inform the medical staff by phone if there is any blood or exudate leakage to confirm whether another follow-up is needed. The patient’s pathological results returned adenomatous polyps with severe heterogeneous hyperplasia of the gallbladder, and the patient was advised to follow up for regular outpatient review. Since laparoscopic cholecystectomy, the gallbladder has been cut out and no gallbladder discharges bile, the patient may experience diarrhea, which is normal and need not be overly worried. In terms of diet, patients should have a low-fat diet and should not eat too much oily food, raw and cold food. In life, avoid staying up late, keep a good sleep, adjust emotions appropriately and maintain a good state of mind, which is conducive to the recovery of the disease.
V. Personal insight
Adenomatous polyp of gallbladder is a lesion that protrudes or bulges from the wall of gallbladder into the gallbladder, most patients are asymptomatic and can be detected by ultrasound in physical examination. Adenomatous polyps of gallbladder are precancerous lesions of gallbladder cancer. The patient in this case was found to have gallbladder adenomatous polyps, which are gallbladder polyps with malignant tendency and require surgery. Laparoscopic cholecystectomy is less invasive and has a faster recovery, which is increasingly acceptable to more and more patients.
In addition, adenomatous polyps of the gallbladder are not terrible, and if abnormalities appear, early detection, diagnosis and treatment are recommended.