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Abstract: The patient in this case is an elderly woman who presented with symptoms such as decreased appetite, bloating after eating, and abdominal pain six months ago, but was not treated.
Basic information】Female, 63 years old
Disease Type】Gallbladder obstruction
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】June 2021
Treatment plan】Surgical treatment (laparoscopic cholecystectomy) + medication (cefuroxime sodium for injection)
Treatment period】5 days of hospitalization and regular review
Effectiveness of treatment】Increased appetite, abdominal distension and pain after eating disappeared
I. Initial interview
The patient is a 63-year-old female with no history of chronic disease. Six months ago, she developed a loss of appetite with no obvious cause, and her food intake decreased compared with the previous one, without a feeling of food obstruction, accompanied by abdominal distension, and the symptoms of abdominal distension were obvious after eating; she occasionally had abdominal pain, mainly in the right upper abdomen, without diarrhea, accompanied by a feeling of weakness; her stool was dry once a day; she occasionally had a cough and coughed up white sputum; and her mental status was poor. He had not received any targeted treatment and came to our outpatient clinic today for systematic diagnosis and treatment. On physical examination, no mass was palpable in the whole abdomen, mild epigastric pain, no rebound pain, abdominal percussion sounds, and negative mobile turbid sounds. He was then admitted to the hospital for further treatment with the cause of loss of appetite to be investigated.
II. Treatment history
After the patient was admitted to the hospital, routine blood tests, blood biochemistry, abdominal ultrasound and other related tests were performed to clarify the cause. The abdominal ultrasound showed multiple strong echogenicity in the gallbladder filling cavity, the larger one was about 0.5×0.3 cm with posterior acoustic shadow, and the bile ducts inside and outside the liver were obviously dilated. After communicating with the patient and his family about the patient’s condition, it was decided to perform laparoscopic cholecystectomy. In other words, under general anesthesia, the gallbladder duct and the gallbladder artery were cut, followed by separation of the gallbladder bed, removal of the gallbladder, and closure of the abdominal incision to end the operation. After the operation, the patient’s vital signs needed to be monitored continuously, and cefuroxime sodium for injection was administered intravenously to prevent postoperative infection.
III. Treatment results
The patient had a good postoperative period and could eat a small amount of rice soup and other liquid food on the first day. The surgical incision was basically healed on the third day after surgery, and no complications such as postoperative infection occurred. After the surgical treatment, the patient was relieved of gallbladder obstruction, and the preoperative symptoms such as abdominal pressure pain, loss of appetite and abdominal distension after eating were improved. The patient returned to the hospital for follow-up one month after surgery, and the patient’s mental state was good, and the physical examination showed that the surgical incision had completely healed without other uncomfortable symptoms, indicating that the surgical treatment was effective.
IV. Precautions
The patient’s condition improved after the surgical treatment, and his diet gradually returned to normal, and he was very happy, and I was also happy for the patient’s improvement. At the same time, I also reminded the patient and his family that they should pay attention to diet regulation after discharge from the hospital because the removal of gallbladder will affect the absorption of fat and it takes some time for the body to adapt to this change, so in the 3 months after surgery, the diet should be light and reduce the intake of fat, and the meat should be mainly fish, shrimp and chicken breast with less fat content, and the intake of vegetables and fruits should be increased appropriately. In addition, the patient should return to the hospital for follow-up 1 month after surgery, and if symptoms such as fever, redness and swelling of the incision occur during the home recuperation period, the patient should be followed up immediately.
V. Personal insight
Most of the patients with gallbladder obstruction are the same as the patient in this case, related to gallbladder stones. Patients who meet the indications for surgery, tolerate surgery, and have abdominal pain and other uncomfortable symptoms should be selected for laparoscopic cholecystectomy once they are diagnosed, which can cure the disease completely and prevent further development of the disease with less intraoperative trauma and faster postoperative recovery, which is especially suitable for such older patients in this case.