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Abstract: The patient presented with symptoms of intermittent hyperthermia without other discomfort after extubation due to an indwelling drainage tube after a major cholecystectomy, and was diagnosed with cholangitis by examination after consultation. The patient’s discomfort was effectively improved after systematic treatment, and the prognosis was relatively good.
Basic information】Male, 75 years old
Disease Type】Cholangitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】August 2021
Treatment plan】Oral medications (cefixime tablets, omeprazole enteric capsules, liver protection tablets)
Treatment period】11 days of hospitalization and 6 months of outpatient follow-up
Treatment effect] The patient’s fever disappeared and the cholecystitis was basically controlled.
I. Initial consultation
The patient, an elderly male, visited the clinic 2 months ago with fever and chest pain, and was diagnosed with cholecystitis and gallbladder stones through examination, and underwent a major gallbladder resection. After removing the drainage tube after clamping the cholecystostomy tube without discomfort, the patient developed high fever without other uncomfortable symptoms, such as nausea, vomiting, abdominal pain, abdominal distension, etc. The symptoms improved after self-application of antibiotics, but then developed afternoon fever without other uncomfortable symptoms, and came to the hospital for further clarification of the diagnosis. The patient was found to be in a good mental state and clear, and after questioning, he was told that he was eating normally and urinating and defecating normally, so the initial diagnosis of cholangitis could be made, and hospitalization was recommended for further diagnosis.
II. Treatment
After admission, the patient was examined. The patient’s body temperature and heart rate were normal, while the abdomen was flat, there were no abdominal wall varices, and no gastrointestinal pattern or peristaltic waves, and surgical scars were visible in the median abdomen as well as the right upper abdomen, and the prognosis was good. The patient was then examined for routine blood, liver and kidney functions, as well as CT of the chest and abdomen and MRI of the abdomen. The routine blood results indicated that the white blood cells were significantly elevated, the liver and kidney function results indicated no significant abnormalities, the CT of the chest and abdomen indicated bile duct dilatation, and the MRI of the abdomen indicated bile duct dilatation. After the diagnosis was confirmed, the patient was given cefixime tablets orally for anti-infection treatment, together with omeprazole enteric capsules and liver protection tablets to reduce gastric acid stimulation and protect the liver at the same time.
III. Treatment effect
After drug treatment, the patient’s cholecystitis was relieved. On the 5th day of drug treatment, the patient’s fever was effectively relieved and the routine blood white blood cell value was normalized. On the 11th day of drug treatment, the patient’s fever had basically disappeared and the routine blood white blood cell count had returned to normal, and the patient did not have nausea, vomiting, abdominal pain and other symptoms, and his urine and stool were also normal, suggesting that the situation of cholecystitis had been basically controlled, and the patient was discharged from the hospital.
IV. Notes
The patient’s symptoms have completely improved after treatment, and I am happy for him. Patients should pay attention to maintain good living habits, pay attention to adequate rest, avoid staying up late, and also appropriate outdoor exercise, such as walking, playing tai chi, etc., which can help enhance their own physical fitness. In terms of diet, patients should eat nutritious and light meat, eggs, vegetables and fruits, and avoid spicy and stimulating foods as well as high-fat and high-cholesterol foods. In addition, patients should also maintain a positive and optimistic attitude, avoid emotional tension and anxiety, so as not to be detrimental to disease recovery.
V. Personal insight
The patient in this case has biliary ductitis due to postoperative drainage tube removal, and the general population should also be warned that extra attention should be paid to the care of postoperative patients, especially elderly patients, who are relatively weak and more prone to infectious diseases. However, if infectious diseases have already appeared, there is no need to worry too much. As long as targeted treatment is carried out through active medical consultation, most of the uncomfortable symptoms can be effectively relieved and the prognosis is also relatively good, but if no treatment is carried out, it may lead to aggravation and even complications such as bacteremia and bile duct cancer.