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Abstract: A 51-year-old female patient had undergone a minimally invasive cholecystectomy for gallbladder stones in a local hospital in the past.
Basic information】Female, 51 years old
Disease Type】Bile Duct Injury
Hospital】Hunan Provincial People’s Hospital
Date of consultation】May, 2022
Treatment plan】Surgical treatment (laparoscopic bile duct jejunostomy) + medication (ceftazidime for injection)
Treatment period】7 days in hospital, regular review
Results】Stones were basically removed, the bile duct was open, there was no obvious bleeding or fluid in the abdominal cavity, and the patient recovered well after surgery.
I. Initial consultation
The patient had undergone laparoscopic cholecystectomy in a local hospital for gallbladder stones. During the operation, the doctor found that the anatomical location of the patient’s bile duct was different from that of a normal person and there was anatomical variation. The patient then came to our hospital for consultation. Blood tests revealed that the patient’s direct bilirubin, ghrelin and ghrelin levels were elevated; magnetic resonance imaging revealed that the patient’s hepatoportal bile ducts were stenosed, and the bile ducts above the stenosis were dilated due to bile duct stenosis and poor bile drainage, and a large number of stones existed in the dilated bile ducts.
II. Treatment history
The patient was first treated with anti-infective therapy using ceftazidime for injection, a third-generation antibiotic, to reduce the patient’s inflammation, improve tissue edema, and reduce intraoperative and postoperative inflammatory reactions, while the patient’s general physical condition, such as heart and lungs, was evaluated, and several abnormalities in the patient’s liver function index were assessed. Careful reading of the MRI revealed that the key aspect of the patient’s disease was due to bile duct stenosis caused by bile duct injury, which was treated surgically. The main purpose of the surgery was also to release the bile duct stenosis so that the stones could be removed and at the same time to reduce distant recurrence.
The patient and his family were seriously affected by the recurrent abdominal pain, fever and poor appetite in the past 1 year, and their life and treatment were seriously affected, and they thought that the problem had reached an insurmountable level. After communication with the doctor, they learned that the patient’s problem could not only be solved, but also laparoscopic bile duct jejunostomy could be tried, and the patient and his family rekindled their confidence. After the patient and his family agreed, the patient was given a minimally invasive surgery, during which the patient’s narrow bile duct was released through laparoscopic technique, the bile duct-jejunostomy was finely reconstructed, and the stones were basically removed.
III. Treatment results
The patient recovered quickly after the operation. On the second day after the operation, the anus was exhausted, and on the third day, the patient was allowed to start eating liquid food and getting out of bed, and there were no significant fluctuations in the infection index and liver function when the blood routine and liver function were rechecked.
IV. Notes
I am very pleased with the patient’s recovery. I suggest that the patient should eat regularly after discharge, eat three meals on time, do not overeat at each meal, and try to eat less greasy food and hard-to-digest food, such as fried and glutinous food, etc. At the same time, pay attention to drink more water, move more to the ground, keep the bowels open, and eat more fruits, vegetables, yogurt and food with high fiber content to prevent constipation.
V. Personal insight
Biliary tract injury is one of the more common diseases in biliary surgery. The patient in this case presented with unexplained abdominal pain, and this abdominal pain appeared to increase after eating, and may also present with indigestion such as abdominal distension and poor appetite. Because of the different types of bile duct injury, some patients will also be accompanied by chills, fever, jaundice and other manifestations of cholangitis. Some bile duct injuries are more complex, and for different types of bile duct injuries, different surgical methods should be chosen, and the surgical operation should be delicate to avoid serious surgical complications.