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Abstract: Duodenal obstruction is a common surgical emergency abdomen, with some patients having an acute onset and producing persistent abdominal cramps with nausea. As in this case, the patient is a 55-year-old male with a history of appendicitis surgery 20 years ago. In the last 2 days, he presented to the hospital with abdominal colic without obvious causes, accompanied by vomiting, and after abdominal examination, CT and other examinations, it was clear that duodenal obstruction was present, and he was admitted to the hospital to receive gastrointestinal decompression + drug therapy.
Basic information】Male, 55 years old
Disease Type】Duodenal obstruction
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】November 2021
Treatment plan】Gastrointestinal decompression (nasogastric tube + enema) + medication (Ceftriaxone sodium for injection + Scopolamine hydrochloride injection + Potassium chloride injection) + water fasting
Treatment period】Inpatient treatment for 3 days, outpatient review after half a month
Treatment effect]: Abdominal pain and vomiting disappeared, and the patient recovered well and was discharged from the hospital.
I. Initial consultation
A middle-aged male came to the clinic with his hands over his stomach and a painful expression. The patient reported that last night, he had abdominal pain with no obvious cause, and the pain was severe and colicky, radiating to his back. This morning, he vomited once and the pain was relieved, and said that he had undergone appendicitis surgery 20 years ago. After briefly understanding the condition, a specialist examination was performed, and the patient was asked to lie flat on the treatment bed with hips and knees flexed. Based on the patient’s symptoms and signs, the patient was initially diagnosed with duodenal obstruction. The patient was recommended to be admitted to the hospital for further examination and treatment, and the patient was immediately hospitalized.
II. Treatment history
After admission, abdominal CT, routine blood and urine tests were performed, and CT results showed pneumatosis in the intestinal cavity and pancreatitis was not excluded. The repeat blood amylase was normal and pancreatitis was ruled out. The patient’s diagnosis was clearly duodenal obstruction. For this patient, the treatment plan was: anti-inflammatory and anti-infective treatment + gastrointestinal decompression. Firstly, after giving nasogastric tube and enema treatment to help gastrointestinal decompression, the patient reported that the pain was significantly reduced, and was promptly given ceftriaxone sodium for injection, anti-inflammatory and anti-infective, and scopolamine hydrochloride injection to release spasm; meanwhile, potassium chloride and potassium supplementation were given to adjust water-electrolyte disorder. The patient was also instructed to abstain from water to avoid aggravating abdominal pain and distension.
III. Treatment effect
After the patient was treated with anti-inflammatory and anti-infective therapy, corrected water-electrolyte disorders, and given a nasogastric tube and enema for gastrointestinal decompression, the patient reported that the previous abdominal pain was significantly reduced. After 3 days of conservative treatment in hospital, the patient’s abdominal pain disappeared completely, resumed defecation, diet had returned to normal, no symptoms of nausea and vomiting, abdomen was flat and no bulge was seen, the patient recovered well and was discharged. The patient was instructed to come back to the hospital for review after half a month, and the patient had no obvious discomfort and was in good condition.
IV. Notes
After active and effective treatment, the patient has no more symptoms of abdominal pain and vomiting and has completely recovered from the disease, so we are sincerely happy for him. After discharge from the hospital, the patient should pay attention to rest and avoid strenuous exercise, and can do moderate exercise such as walking and jogging. On the diet, eat little and often, do not overeat, try not to drink, and avoid cold, stimulating, dry and hard food to stimulate the mucous membrane. It is recommended to eat foods high in vitamins to reduce the pressure of the intestine and improve the condition of intestinal obstruction; appropriate consumption of coarse grains, such as oatmeal porridge, corn steamed buns, millet porridge, etc., can promote intestinal peristalsis and prevent intestinal obstruction. In addition, the abdomen can be appropriately massaged to keep the bowel movement smooth. If the patient has discharged from the hospital and again experiences abdominal pain, abdominal distension, nausea, vomiting and other uncomfortable symptoms, he should seek medical follow-up as soon as possible.
V. Personal insight
Duodenal obstruction is a kind of acute abdominal disease caused by various reasons, which occurs mostly in modern times after overeating, drinking alcohol, eating raw, cold and hard food, and because the food is not easily digested, obstruction is extremely easy to occur at the site of intestinal adhesions. Milder cases such as this patient can be treated by fasting water, gastrointestinal decompression, enema and laxative, intravenous fluids, etc., and can return to normal in about 1 week; if the condition is serious, the patient may have intestinal necrosis, at any time critical life, should be promptly operated. In addition, in addition to the necessary treatment, compliance with medical advice, regular review, adjustment of poor diet and lifestyle habits is a very important part of the recovery of the disease.