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Abstract: Duodenal obstruction belongs to a type of duodenal obstruction, which is clinically manifested by abdominal pain, nausea, and vomiting. As the patient in this case, she reported abdominal pain, nausea and vomiting without clear cause, and was diagnosed as duodenal obstruction in a foreign hospital, which did not improve after treatment, so she visited the hospital again. After surgical examination, the diagnosis was clarified, and the patient was given gastrointestinal decompression + medication, and after 4 days of hospitalization, the patient was in fair general condition, and the abdominal pain and vomiting symptoms disappeared.
Basic information】Female, 32 years old
Disease Type】Duodenal obstruction
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】January 2022
Treatment plan] Gastrointestinal decompression (enema + nasogastric tube) + medication (levofloxacin lactate sodium chloride injection + hypromellose hydrochloride injection + sodium chloride injection + ceftriaxone sodium for injection)
[Treatment cycle] Hospitalization for 4 days, outpatient review after half a month
Treatment effect】The patient’s general condition is fine, abdominal pain, nausea and vomiting symptoms disappeared
I. Initial consultation
A middle-aged woman of about 30 years old was assisted in the outpatient clinic with her stomach covered. She reported that she had abdominal pain without any clear cause 2 days ago, which was sharp and paroxysmal, with the right upper abdomen being the heaviest, without radiation from other places; she had nausea and vomiting twice, and the vomit was stomach contents, not containing blood, roundworms, or coffee-like material. There was no chill, fever, shortness of breath, cough and sputum, frequent urination, painful urination and hematuria, and the patient was diagnosed with duodenal obstruction after the onset of the disease. Subsequently, a specialist examination was performed for the patient, and the surgical situation was as follows: abdominal breathing was diminished, an 8-cm-long incision scar was visible in the right upper abdomen via the rectus abdominis muscle, the abdomen was slightly distended, there were no varices in the abdominal wall veins, no intestinal pattern or retrograde peristaltic waves were seen, the liver and spleen were not reached under the rib cage, there was no percussion pain in the liver area and both kidney areas, pressure pain throughout the abdomen, there was no rebound pain or muscle tension, with the right upper abdomen being the heaviest, bowel sounds were 6-8 times/min, and gas-over-water sounds and metallic sound. The patient was initially diagnosed as having duodenal obstruction and was recommended to be hospitalized, and the patient was then admitted.
II. Treatment process
After the patient was admitted to the hospital, the patient’s condition and past history were inquired in detail, and it was learned that the patient had a history of duodenal ulcer perforation repair surgery 5 years ago, denied the history of trauma and drug allergy, and denied the history of contact with infectious diseases such as hepatitis and tuberculosis. The results of routine blood, urine, liver and kidney function, electrolytes, coagulation function, infectious disease screening and other tests necessary for surgery were all unremarkable. The abdominal X-ray showed that dilated pneumatization and multiple air-fluid planes were visible in the small intestine, and the diagnosis was duodenal obstruction. The initial treatment plan was as follows: water fasting, gastrointestinal decompression, clean enema with 800 ml of warm soapy water, static antibiotics and fluid support treatment were given after admission. If conservative treatment was ineffective, surgical treatment was considered. Treatment was then started, and the patient was first given a nasogastric tube, gastrointestinal decompression, and levofloxacin lactate sodium chloride injection intravenously for anti-inflammatory and anti-infective; racemic scopolamine hydrochloride injection + sodium chloride intravenously to release spasm; ceftriaxone sodium + sodium chloride injection intravenously to give potassium supplementation.
III. Treatment effect
After systematic and effective treatment, the patient’s condition was reduced after one day of treatment, vomiting once and defecating once; after 3 days, the patient’s abdominal pain symptoms were significantly reduced, no nausea and vomiting, and resumed a liquid diet; the patient was hospitalized for 4 days, and his general condition was fine, he did not complain of other special discomfort, his mental, sleep and diarrhea conditions were fine, the patient had no abdominal pain symptoms, no nausea and vomiting, resumed exhaustion, defecation and The patient was discharged with no abdominal pain, no nausea and vomiting, resumption of gas, defecation and normal diet. Before discharge, the patient was instructed to come to the hospital for a review in half a month, pay attention to diet and rest after going home, and avoid eating spicy and stimulating food and cold food.
IV. Notes
We are glad that the patient was discharged from the hospital after systematic and active treatment. For duodenal obstruction, we need to pay attention to the diet, avoid spicy and stimulating food, as well as cold food; easy to digest, easy to absorb, soft and rotten food, avoid dry and hard food and coarse fiber food, so as not to affect the mucosa of the digestive tract or stimulate the patient’s body, and avoid overeating. In addition, you should pay attention to proper physical exercise, but not strenuous exercise after meals. If abdominal pain, bloating, vomiting, stopping defecation and other uncomfortable symptoms occur, it may be a recurrence of duodenal obstruction, so come to the hospital in time.
V. Personal insight
Duodenal obstruction should not be taken lightly by anyone because of the possible risk of death. In this case, the patient had abdominal surgery, and after abdominal surgery, abdominal adhesions may occur leading to recurrent duodenal obstruction, and the patient has recurrent abdominal pain, abdominal distension, nausea, and vomiting. Therefore, fasting, fluid replacement, anti-infection and other treatments are given and combined with transnasogastric decompression. Transnasogastric decompression is the most commonly used and more effective method, but due to the limitation of the length of the nasogastric tube itself, a certain decompression effect can be obtained only for high obstruction, and it is less effective for low obstruction. In addition, it is important to note that the extent to which conservative treatment is appropriate requires accurate judgment. If the patient has poor decompression and drainage, abdominal pain and distension are not relieved, or even poor intestinal blood flow due to prolonged obstruction, the possibility of intestinal necrosis may occur. Therefore, the patient’s condition must be closely observed after conservative treatment, and if the symptoms are not relieved, immediate surgical treatment is required.