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Abstract: The patient in this case is a 57-year-old female patient who came to the clinic with sudden onset of abdominal pain for 1 day. Examination showed that the patient had periumbilical pressure pain with mild rebound pain and localized muscle tension, and the final diagnosis was secondary peritonitis with intussusception and small bowel lipoma. After surgical and pharmacological treatment, the patient recovered well and the signs of peritonitis had disappeared, and the patient was discharged successfully.
Basic information】Female, 57 years old
Disease Type】Secondary peritonitis
Hospital】Jinzhou Central Hospital
Date of consultation】May 2022
Treatment plan】Surgical treatment (partial small bowel resection) + medication (injectable meropenem, levonidazole sodium chloride injection)
Treatment period】11 days of hospitalization
Effectiveness】Good recovery, signs of peritonitis disappeared, discharged successfully
I. Initial consultation
The patient came to the hospital with sudden abdominal pain for one day, and was considered to have intestinal entrapment after completion of abdominal CT examination in the outpatient clinic.
The patient said that he had abdominal pain and discomfort in the past 1 month, with intermittent episodes, and this time he came to the clinic urgently because of severe pain without relief.
II. Treatment
After physical examination and preliminary judgment, the patient underwent emergency preoperative routine examination, including routine blood count, coagulation function, blood type, biochemistry and other related tests, and explained to the patient that his condition was aggravated and the diagnosis of secondary peritonitis was clear, considering the possibility of secondary peritonitis caused by intestinal entrapment, and suggested the patient to undergo emergency surgery.
The laparoscopic exploratory surgery was performed under emergency general anesthesia. Intraoperative diagnosis: 1, secondary peritonitis; 2, intussusception; 3, small intestinal lipoma.
After the operation, the patient returned to the ward and was given anti-inflammatory treatment with injectable meropenem and levonidazole sodium chloride injection.
III. Treatment effect
After surgical treatment, the patient was cured of secondary peritonitis, the small intestinal lipoma was removed, the intestinal loop was released and the intestine was reanastomosed, and the patient was free of discomfort after surgery, and the abdominal pain was resolved. After 11 days of comprehensive inpatient treatment, the patient resumed eating and had normal exhaustion and defecation. The patient recovered well, the results of relevant postoperative physical and chemical tests were normal, the patient’s mental status was good, the incision was healed in one stage, the patient was discharged with stitches removed, and the patient was discharged.
IV. Notes
We are really happy for the patient’s recovery, but we also need to advise the patient to pay more attention to rest after discharge. More activities can be appropriate to promote gastrointestinal peristalsis and reduce the occurrence of adhesions in the abdominal cavity.
In addition, when the weather changes, we should pay attention to keep warm, appropriate abdominal hot compress, regular review of abdominal CT and other related examinations, check biochemical and ionic changes, and recommend timely consultation and treatment at the general surgery clinic if there are changes in the condition.
V. Personal insight
Secondary peritonitis belongs to the acute abdomen of general surgery, the onset of this patient is relatively urgent and requires timely treatment, if the treatment is not timely, the symptoms of intra-abdominal infection are serious and may be life-threatening. In addition, this patient has intussusception, so extra vigilance is needed for intestinal tumors, and attention needs to be paid to the occurrence of secondary intestinal necrosis, and timely surgical treatment is of key importance for the treatment and recovery of patients with secondary peritonitis.
For people with chronic abdominal pain, relevant tests should be completed as soon as possible to clarify the cause, exclude intestinal tumors and other conditions, early detection, early diagnosis and early treatment.