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Abstract: A 77-year-old grandmother Wang visited our hospital with recurrent abdominal pain. She complained that the pain was more severe this time compared with the previous two episodes and was accompanied by nausea and vomiting, and gallbladder stones with cholecystitis could be diagnosed by palpation as well as abdominal ultrasonography and routine blood tests. The T-tube was finally removed 1 month after discharge.
Basic information】Female, 77 years old
Disease Type】Gallstones
Hospital】Shandong Provincial Hospital
Date of consultation】January 2022
Treatment plan】Surgical treatment (laparoscopic cholecystectomy) + intravenous injection (gentamicin sulfate injection)
Treatment period】2 weeks of hospitalization and 1 month after discharge for review
Treatment effect】The physical discomfort gradually disappeared, and the abdominal ultrasound examination, routine blood tests and palpation results were normal.
I. Initial consultation
The 77-year-old grandmother Wang came to our hospital with right upper abdominal pain lasting for 5 hours. Upon inquiry, she had previously been admitted to the hospital for gallstone attacks in 2019 and 2020, and after treatment with ursodeoxycholic acid tablets, both acute attacks improved. However, this time, the pain was persistent and dull, and there were symptoms of nausea and vomiting, but there was no other physical discomfort. The abdominal ultrasound examination revealed strong echogenicity in the gallbladder that could change with body position, which was considered to be gallbladder stones, a type of gallstones.
II. Treatment history
After the diagnosis of gallbladder stones, laparoscopic cholecystectomy was considered for the treatment of Wang’s grandmother, considering her severe symptoms and recurrent abdominal pain. Then, a pneumoperitoneum needle was used to inject a certain amount of gas into the abdominal cavity. Under the action of the gas, the operable space in the abdominal cavity was enlarged, after which the artery, cystic duct, and gallbladder of the gallbladder triangle were removed through the four surgical operation holes already established, thus achieving gallbladder removal. Postoperatively, a T-tube was left in place to drain the bile and to promote the self-discharge of the remaining stones. Gentamicin sulfate injection was also used to prevent wound infection.
III. Treatment results
After 2 weeks of postoperative hospitalization, Grandma Wang did not experience any somatic discomfort, and the symptoms of persistent dull pain in the right upper abdomen, nausea and vomiting disappeared. However, it was recommended to discharge the clamped T-tube for observation for 1 month to avoid recurrence and re-installation. 1 month later, the results of the review were normal and Grandma Wang did not have any physical discomfort, so it was considered that the T-tube could be removed.
IV. Precautions
I am very happy that Grandma Wang’s condition improved after laparoscopic cholecystectomy and postoperative use of gentamicin sulfate injection to prevent infection, but the following matters need to be noted after discharge to avoid recurrence of the disease.
1, after discharge from the hospital, grandmother Wang should pay attention to avoid the intake of high-fat and high-cholesterol food, such as pork liver, chicken heart, etc., try to eat lightly, do not put too much oil in the meals, otherwise the intake of too much fat may also induce gallbladder stones.
2, after discharge from the hospital should pay attention to appropriate exercise, more walks after meals, pay attention to more exercise muscles and bones, enhance physical fitness, is also very good for health.
3. If abdominal pain, abdominal distension, nausea and other physical discomfort occur after discharge, the possibility of recurrence of gallbladder stones cannot be ruled out, so it is recommended to return to the hospital for treatment again in time.
V. Personal insight
Gallbladder stones are gallstones, mostly related to long time high oil diet, insufficient activity, excessive obesity, slow metabolism, etc., which can mostly cause gallbladder infection and inflammation. If there are not many gallbladder stones, no obvious complications and no obvious somatic discomfort, it is usually sufficient to treat gallbladder stones by using drugs to promote stone dissolution and anti-infective drugs to treat cholecystitis, but Grandma Wang has had recurrent attacks and obvious somatic discomfort, so surgery is preferred for treatment. Since she is a senior citizen, a relatively safe surgical procedure will be chosen for treatment, so there is no need to be overly anxious.