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Abstract: A 55-year-old female patient suddenly felt chest tightness and discomfort 1 week ago, without other discomfort such as diarrhea, fever and malaise, which was ignored at that time, but recently the discomfort was more intense, and came to our hospital based on her discomfort symptoms, signs and laboratory test results, which could be diagnosed as gallbladder polyps combined with cholecystitis.
Basic information】Female, 55 years old
Disease Type】Gallbladder polyp
Hospital】The First Hospital of China Medical University
Date of Consultation】May, 2020
Treatment plan】Surgical treatment (gallbladder polyp removal surgery) + medication (levofloxacin injection, cefixime tablets)
Treatment period】In-hospital treatment for 3 days, review the disease after 7 months
Treatment effect] The disease has been controlled, the symptoms of chest tightness have disappeared, and no abnormalities were found in the ultrasound examination.
I. Initial consultation
When I first saw the patient, he told me that he usually felt chest tightness and discomfort 1 week ago, but he did not have diarrhea, shortness of breath, fever, chills, or fatigue, etc. He ignored the discomfort because it was mild, but recently his symptoms became more obvious, so he sought medical consultation. During physical examination, no abdominal wall varices, no rebound pain, negative Murphy’s sign, no percussion pain in the liver and kidney area, positive pressure pain in the upper abdomen, and multiple slightly strong echogenicity in the anterior and posterior walls of the gallbladder with no posterior acoustic shadowing were found during perfect ultrasound examination, which combined with the results obtained, led to the diagnosis of gallbladder polyps and cholecystitis.
II. Treatment process
After full communication with the patient and his family, I suggested the patient to take timely biliary polyps surgery to prevent the progression or deterioration of the disease, and the patient and his family agreed. After general anesthesia, a small incision was made under the right side of the patient’s rib cage, and the bottom of the gallbladder was cut open after entering the abdominal cavity. Afterwards, the endoscope was inserted into the gallbladder cavity along the small incision, and the gallbladder polyp was found and removed immediately. After the operation, the patient was given levofloxacin injection and cefixime tablets to prevent infection and control inflammation.
III. Treatment effect
On the day after surgery, the patient was clear and in good mental condition. During physical examination, the patient was found to have a soft abdominal wall, positive epigastric pressure pain, no rebound pain, negative Murphy’s sign, and stable vital signs, and the surgery progressed smoothly. On the second day after surgery, the patient’s sleep, diet and bowel movements were not abnormal, and the surgical incision site did not show a lot of blood, exudate and pus flow, and the discomfort of chest tightness was relieved. On the third postoperative day, the disease was under control and the chest discomfort had disappeared, and the ultrasound examination showed no abnormality, so the patient was discharged normally.
IV. Precautions
1, after surgery, the body is usually weak, I told the patient should do a good job to keep warm, eat less high fat and high cholesterol food, appropriate more eggs, milk, bananas, fish and other highly nutritious food, so as to make a balanced nutritional intake, so as to help maintain the immune system work, to help promote the improvement of the disease.
2.If you find yourself with certain abnormalities during the treatment period, such as fever, nausea, abdominal pain or obvious pain from surgical incisions, you should inform your doctor immediately, after which we will take appropriate treatment measures with the specific situation.
3. I informed the patient that gallbladder polyps have a certain tendency of malignant transformation, and repeatedly advised the patient to seek medical review on time, so as to keep an eye on the changes of the disease.
V. Personal insight
Gallbladder polyp is a disease that may not have any symptoms in the early stage, after which most people will experience abdominal pain, nausea, vomiting and other symptoms, but some people do not have typical symptoms, for example, like the patient in this case may just have chest discomfort, which may be caused by the radiating pain of biliary colic. Therefore, if you experience discomfort, it is recommended to seek medical attention in a timely manner, even if the discomfort is mild, do not ignore it, otherwise the symptoms will worsen and you may even miss the best time for treatment. The prognosis of gallbladder polyps is usually better if they are not malignant, like the patient in this case, the disease has been controlled after systematic treatment and good daily care, and no recurrence or malignant tendency was seen during outpatient review.