(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed to protect Mr. Li’s privacy)
Abstract: A 65-year-old Mr. Li was admitted to the hospital with abdominal pain with nausea and vomiting for 1 week. After perfecting standing abdominal plain film and abdominal CT, he was initially diagnosed with adhesive small bowel obstruction, and his symptoms were reduced after standardized treatment of fasting, gastrointestinal decompression and nutritional support. The disease belongs to the category of mechanical intestinal obstruction, some of which can be treated non-surgically to obtain symptom subsidence, and for those who have recurrent attacks or conservative treatment is ineffective, surgical treatment can be performed.
Basic information】Male, 65 years old
Disease Type】Adhesive small bowel obstruction
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】January 2022
Treatment plan] Gastrointestinal decompression + medication (growth inhibitor for injection + furosemide injection + sodium chloride injection)
Treatment period】2 weeks of inpatient treatment, 3 months of follow-up
Treatment effect] Mr. Li’s abdominal pain, nausea and vomiting symptoms were relieved compared with before
I. Initial consultation
Three days ago, Mr. Li came to the clinic with his stomach covered. I helped him sit down and began to ask him the reason for his visit. Mr. Li reported abdominal pain with nausea and vomiting for 1 week, and had a history of colon cancer resection in the past. The abdominal CT findings suggested that the dilated, fluid-filled small bowel collaterals suddenly changed into a contracted small bowel with focal kinking and lumen narrowing. Combined with Mr. Li’s past medical history and clinical manifestations, the initial diagnosis was adhesive small intestinal obstruction, and the examination of Mr. Li’s pulse, blood pressure, heart rate and respiration did not show any significant abnormalities, so he was admitted to our hospital for treatment.
II. Treatment process
After Mr. Li was admitted to the hospital, we further improved the blood routine, C-reactive protein, urine routine, coagulation function, liver and kidney function, hepatitis B and half, blood lipid, blood sugar, syphilis spirochete antibody test and other tests to assess Mr. Li’s general condition. Based on Mr. Li’s current symptoms, we adopted non-surgical treatment to minimize the amount of intestinal contents, reduce intestinal lumen pressure, eliminate intestinal edema, maintain internal homeostasis, and improve Mr. Li’s nutritional status as the main treatment principles. Firstly, Mr. Li was instructed to fast, perform gastrointestinal decompression, put the tip of the gastrointestinal decompression tube to the proximal end of the obstruction to keep the intestinal canal empty; use sufficient amount of injectable growth inhibitor to minimize the secretion of digestive juices; use furosemide injection to diuretic to relieve intestinal wall edema; supplement sodium chloride injection for nutritional support treatment.
III. Treatment effect
After 2 weeks of standardized treatment, Mr. Li’s abdominal pain, nausea and vomiting symptoms were better than before, no obvious pressure pain was palpated on abdominal examination, good defecation and exhaustion, and daily checkups showed that Mr. Li’s symptoms gradually improved. Repeated standing abdominal plain film and abdominal CT examination did not show any significant abnormalities. After discussion, Mr. Li and his family wanted to be discharged home to recuperate. According to Mr. Li’s condition, he did not complain of any significant discomfort, so he was discharged with medication. During the following 3-month follow-up, Mr. Li did not complain of any special discomfort, and the treatment effect was good.
IV. Notes
We are glad that Mr. Li’s condition has improved after active treatment, but the treatment is not over yet. After discharge, you must follow the doctor’s prescription for regular review and medication, and at the same time, rest and diet also play a great role in the recovery of the disease, so you must have a healthy diet and regular rest.
1.After Mr. Li’s discharge from the hospital, he should still follow the doctor’s prescription to take oral medication regularly and quantitatively to achieve good treatment effect.
2, after discharge from the hospital, pay extra attention to the diet, mainly liquid food first, to avoid excessive intake of hard food, so as not to increase the intestinal burden and aggravate the disease.
3, pay attention to rest, avoid frequent late nights, ensure sufficient sleep, and maintain a relaxed mood, avoid tension, mental stress, is very important for disease recovery.
4, if Mr. Li appears to have abnormal symptoms of discomfort, promptly go to the hospital, improve X-rays, CT and other auxiliary examinations, clarify the diagnosis of the cause, and develop a standardized individualized treatment plan under the guidance of a professional physician.
V. Personal insight
Adhesive small intestine obstruction is a relatively common clinical gastrointestinal disease, which can be caused by various reasons to obstruct the passage of intestinal contents, resulting in clinical symptoms of abdominal pain, abdominal distension, vomiting, and cessation of exhaustion and defecation. In this paper, Mr. Li has a history of post-operative colon cancer resection, which is often seen as an adhesive small bowel obstruction caused by peritoneal adhesions after abdominal surgery. After standardized treatment, Mr. Li’s symptoms were reduced.
1. Early detection and timely treatment: when there is abnormal discomfort, go to a regular hospital as soon as possible, improve the specialist examination and take targeted treatment according to specific conditions.
2, to develop good habits: pay attention to a reasonable diet, avoid spicy and stimulating, greasy food, and regular rest and proper exercise to enhance body resistance.