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Abstract: A 37-year-old female patient developed jaundice with nausea and vomiting after eating seafood, which was not taken care of, and later developed febrile symptoms and was referred to our hospital. Detailed examination revealed that it was a benign bile duct obstruction due to bile duct stones, which could be cured at the level of surgery, and a more reasonable minimally invasive ERCP lithotripsy was chosen in performing the treatment. The operation went smoothly, and the patient was rechecked 3 months later, with no recurrence of jaundice and abdominal pain, and was cured.
Basic information】Female, 37 years old
Disease Type】Benign bile duct obstruction
Hospital】The First Hospital of Jilin University
Date of consultation】February 2022
Treatment plan】Surgery (minimally invasive ERCP lithotripsy) + medication (adenosylmethionine butanedisulfonate enteric tablets + gardenia yellow granules)
Treatment period】3 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] The symptoms disappeared and the patient was cured.
I. Initial consultation
I was awakened by the phone ringing in the morning, it turned out to be a friend’s phone call, the friend’s voice on the other side of the phone was very anxious, it was a family member of the friend who was sick and wanted me to take a look at it, I hastily agreed and let him lead the patient to the hospital to check it out. The patient was a 37-year-old middle-aged woman in fair mental condition, but her skin and sclera were mildly yellowish. By asking about her condition, I learned that the symptoms had been present for about 2 days. At first, she had nausea and vomiting after eating seafood, but did not pay attention to them, and gradually developed a deepening urine color with a mild fever. The patient first visited the clinic, and after the clinic doctor checked, he informed the patient that it might be a tumor disease, which made the family and the patient very anxious. He took some liver protection drugs at home by himself, but there was no significant relief, so he came to the hospital for further examination and treatment. Since the patient had mild abdominal pain and was not too old, it was not necessarily malignant obstructive jaundice, but could also be some benign disease, so the patient was advised to undergo further diagnosis after the examination.
The patient and family agreed, and plain CT of the liver, bile and pancreas, and bile duct water imaging by MRI were performed. The results came out on the second day and were very good. The CT suggested a high-density shadow at the end of the common bile duct, which was considered more likely to be a stone. The CT showed a high density image of the common bile duct, which was considered to be more likely to be a stone. The results of MRI bile duct imaging also confirmed the diagnosis of a stone, which could be cured with aggressive surgical treatment.
II. Treatment history
After studying the patient’s condition, I found that there were no obvious stones in the gallbladder and the size of the stones in the common bile duct was relatively small, only about 6 mm, so I recommended that she undergo a minimally invasive ERCP lithotripsy. This has several advantages, one is that this procedure can be performed minimally and non-invasively; second, it can be performed without cutting the gallbladder, thus preserving the organ functions of more organs; third, it is also less risky and expensive, and can be discharged quickly. The patient and family were very happy after hearing my presentation and immediately agreed to be admitted to the hospital for treatment. After a detailed preoperative examination and evaluation, the patient underwent the procedure under general anesthesia with a duodenoscope as the surgical instrument. The endoscope was placed in the descending duodenum through the mouth and esophagus to locate the opening of the common bile duct. A retrograde cholangiogram was performed at the duodenal papilla to clarify the location of the stone, and then the stone was removed from the papilla through a small incision in the papilla using a mesh basket and balloon.
Before discharge from the hospital, the patient was instructed to have monthly liver function tests and reviews, and to take some cholestatic drugs such as adenosylmethionine butanedisulfonate enteric tablets and gardenia yellow granules.
Treatment effect
The surgical process was very smooth, and the jaundice of the patient decreased significantly after the operation, and he was able to move around on the first day without any obvious complications such as fever. The patient also ruled out complications related to pancreatitis, biliary ductitis and bleeding 2 days after surgery, and could resume eating and drinking afterwards without any obvious abnormality, and the liver function was basically close to normal on reexamination, so he was discharged from the hospital. At the 3-month postoperative reexamination, the patient did not have obvious abdominal pain and jaundice, and was in good general condition, having recovered to the previous level and rejoined normal work.
IV. Precautions
I was sincerely happy to see the patient gradually recovering and the family was much relieved, but for this kind of patients with bile duct obstruction caused by choledocholithiasis, precautions after discharge are also very important, as follows.
1, after discharge from the hospital should focus on continuing to observe the clinical symptoms, because some patients have residual stones, also appear again obstruction, because when the symptoms appear again may not be obvious in the early stage, easy to have cholangitis and jaundice aggravation, liver function damage, must be diligent observation.
2. If abnormalities appear, attention must be paid to timely consultation for liver function and CT examinations to clarify the situation, and regular re-examinations should also be conducted in accordance with medical advice.
3.After surgery, patients should have a protein-rich and nutritious diet, and avoid spicy and stimulating foods and alcohol.
V. Personal insight
Jaundice is a common clinical manifestation of disease, once jaundice, we should pay sufficient attention to the causes of jaundice, such as cholangiocarcinoma, pancreatic cancer and liver cancer and other malignant diseases make the bile duct malignant obstruction, the prognosis of treatment of such cases is poor, so many patients are more fearful of jaundice, for example, the patient in this case after the suspicion of malignant disease, nervous and anxious, and even self-administered liver protection drugs This is not advisable. When jaundice is detected, the patient should go to the hospital for a definitive diagnosis, not to determine that it is caused by a malignant disease, which may also be caused by benign diseases, such as hepatic insufficiency, common bile duct stones and roundworms, so that a definitive diagnosis can be made for comprehensive treatment.