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Abstract: Secondary peritonitis is mainly caused by intra-abdominal organ lesions, which can lead to infectious shock or even life-threatening conditions if not treated in a timely manner, and is a relatively common acute abdominal condition in general surgery. In this case, a patient with liver abscess secondary to peritonitis came to the hospital with abdominal pain and discomfort, weakness, chills and night sweats for one month, and his condition improved after surgery and medication.
Basic information】Male, 35 years old
Disease Type】Secondary peritonitis, ruptured liver abscess, diabetes mellitus
Hospital】Jinzhou Central Hospital
Date of Consultation】May 2022
【Treatment plan】Surgical treatment (laparoscopic intermediate open liver abscess incision and drainage + abdominal flushing and drainage) + drug treatment (meropenem combined with levonidazole anti-inflammatory + sodium deoxynucleotide combined with glycopyrrolate monoammonium cysteine sodium chloride injection for liver protection)
[Treatment period] The expected treatment period is about 30 days
Treatment effect】Recovery was good, signs of peritonitis had disappeared, and various physicochemical indicators suggested significant improvement.
I. Initial consultation
The patient came to the hospital with sudden onset of abdominal pain and discomfort for 1 day, malaise, chills with night sweats for 1 month, and a grayish complexion and mild anemic appearance.
The preliminary diagnosis was secondary peritonitis and ruptured liver abscess. After detailed medical history, we learned that the patient had elevated blood glucose 3 years ago and was diagnosed with diabetes mellitus at that time, but was not treated systematically. After physical examination and preliminary judgment, the patient underwent urgent preoperative routine examination, including routine blood, coagulation function, blood type, biochemistry and other related tests, and explained to the patient that his condition was aggravated, the diagnosis of secondary peritonitis was clear, and there was peritoneal effusion, and the possibility of liver abscess rupture was considered high, and emergency surgery was recommended.
II. Treatment process
After discussing with the patient, the patient agreed to undergo laparoscopic surgery, and then underwent emergency laparoscopic exploratory surgery under general anesthesia, during which a large amount of pus was found around the liver and pelvis, and the abscess was located high on the diaphragmatic surface of the liver. The patient returned to the ward, and postoperative anti-inflammatory and other symptomatic treatments were performed, namely, meropenem combined with levonidazole anti-inflammatory treatment, sodium deoxynucleotide combined with glycopyrrolate monoammonium cysteine sodium chloride injection for liver preservation.
III. Treatment results
The patient was treated surgically and the intra-abdominal pus was suctioned and flushed and drained to further relieve the cause of the disease, while actively controlling the infection in the abdominal cavity. After surgery, the patient recovered well, and the abdominal pain was significantly relieved and gradually disappeared. On the 6th postoperative day, the whole abdominal CT examination showed that the abscess was significantly reduced in scope, and there are no uncomfortable symptoms at present.
IV. Notes
If the residual abscess is still liquefied and the abdominal drainage tube cannot drain sufficiently, ultrasound-guided perforated drainage is feasible to help the abscess recover, and after the abscess is completely absorbed, the patient can be discharged. After the abscess is completely absorbed, the patient can be discharged.
It is recommended that the patient should pay more attention to rest and avoid straining after discharge, appropriately strengthen nutrition and eat more fresh vegetables and fruits, and the patient should reasonably regulate blood sugar to avoid the recurrence of diabetes-related complications, and should come to the hospital for a follow-up liver ultrasound examination one month after discharge to clarify whether there is a recurrence of abscess and to test the blood liver function index.
V. Personal insight
Secondary peritonitis is an acute abdominal disease in general surgery, which usually has an emergency onset and needs to be treated in a timely manner, if not treated in time, the symptoms of intra-abdominal infection are serious and life-threatening, and liver abscess is one of the complications related to diabetes, so diabetic patients like this patient should control their blood sugar well, pay more attention to rest and avoid overexertion, and if liver abscess is diagnosed, it must be treated early In addition, if liver abscess is diagnosed, it must be treated early to avoid rupture causing secondary peritonitis and even life-threatening.
In addition, the occurrence of secondary peritonitis can be effectively prevented by paying attention to regular diet, good rest, hygiene and safety, as well as active treatment of primary diseases such as liver disease and digestive system diseases. If there are uncomfortable symptoms must be promptly consulted and treated symptomatically, do not delay.