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Abstract: There are many kinds of biliary tract diseases, most of which are stones or tumors. Sometimes the stones or tumors are not clearly distinguishable, and surgical exploration is required to understand them. Recently, a patient presented to our hospital with yellowing skin for half a month, and the relevant tests suggested a terminal bile duct occupancy, but it did not look like a typical tumor. The patient was given a surgical exploration of the common bile duct and was seen to have a stone at the end of the common bile duct with no obvious tumor manifestation, which was subsequently removed and the patient was discharged.
Basic information】Male, 65 years old
Type of disease】Choledocholithiasis
Hospital】Liaocheng People’s Hospital
Consultation time】November 2021
Treatment plan] Common bile duct exploration + choledochotomy for stone extraction
Treatment Period】10 days in hospital
Results】Stone removal, good postoperative recovery
I. Initial consultation
Today, a patient came to the clinic with yellow skin and yellow urine, accompanied by chills and fever, and a temperature of about 39℃. This condition usually suggests biliary tract disease, but biliary tract disease commonly includes stones or tumors. Therefore, in order to clarify the specific disease of the patient.
The liver function indicated that the transaminases and bilirubin were significantly elevated, suggesting obstructive jaundice, and CA199 was also significantly elevated, which could not be excluded as a tumor. At the same time, ultrasound and abdominal intensive CT examination were performed, both of which indicated terminal bile duct occupancy, and tumor was not excluded.
II. Treatment process
After admission, our department held a discussion and concluded that the occupancy at the end of the bile duct was different from the typical tumor manifestation by CT, but the possibility of stone could not be excluded. If the surgical exploration does not reveal a clear tumor lesion but a stone, the stone will be removed and the surgery will be completed. However, if the common bile duct exploration reveals a tumorous lesion, a more extensive surgery, i.e., pancreaticoduodenectomy, may be performed.
The patient and his family agree to the treatment plan, and the patient is electively operated on under general anesthesia for common bile duct exploration. The choledochoscope revealed a stone at the end of the cystic duct, and no obvious tumor lesion was found after the stone was removed.
III. Treatment effect
The treatment effect is more definite as the stone was confirmed and removed from the common bile duct during the operation, and there is no postoperative recurrence as it is not a tumor lesion. The laparoscopic surgery for common bile duct stones was less invasive, and the patient recovered quickly after the operation, and was able to get out of bed on the first day after the operation.
During the postoperative review, the patient’s bilirubin gradually decreased, jaundice also gradually reduced, and the skin gradually changed to a normal color. The patient’s appetite was getting better and better, the amount of food was getting better and better, and the general condition was obviously improved, and the patient could resume normal diet and be discharged after 10 days of hospitalization, and the patient’s treatment effect was more accurate and satisfactory.
IV. Notes
We are glad that the patient was cured after the treatment, but the patient should be reviewed regularly after the operation of common bile duct stone, once every six months with abdominal ultrasound or abdominal CT, and a drainage tube should be placed after the choledochotomy to avoid dislodgement. In terms of diet, the patient should try to eat less fatty food for about a month, because the digestive function will be affected to a certain extent at this time, but the digestive function will gradually return to normal.
V. Personal insight
Biliary tract diseases commonly include stones or tumors. Stones and tumors have different treatment modalities because they are different conditions, so it is important to make a clear diagnosis as much as possible before surgery. If the diagnosis is not clear before surgery, timely surgical treatment is also needed so that the specific disease can be clarified and targeted treatment can be performed. In general, the prognosis for stone disease is better, as the disease can be cured after the stones are removed, but the patient needs to be reviewed regularly after surgery.