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Abstract: The patient in this case is an elderly male who came to our hospital one month ago after experiencing vague pain in the upper abdomen accompanied by loss of appetite, acid reflux and other uncomfortable symptoms, and the uncomfortable symptoms did not improve after taking medication on his own. He was diagnosed with cholecystitis after related examination and underwent surgery.
Basic information】Male, 75 years old
Disease Type】Cholangitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic cholecystectomy) + medication (omeprazole enteric capsules)
Treatment period】5 days of hospitalization, 3 months of outpatient follow-up
Treatment effect] The condition improved, and the discomfort disappeared.
I. Initial consultation
The patient was 75 years old, with a history of diabetes mellitus for more than 7 years, and his family reported that the patient had poor eating habits and did not like to drink water. 1 month ago, he had a significant decrease in appetite and fatigue with no obvious cause, accompanied by epigastric paroxysmal vague pain and discomfort, without progressive aggravation; he had yellow urine and itchy skin; he occasionally had acid reflux and heartburn, and was treated with Sifu pill orally outside the hospital, but the effect was average and the discomfort did not improve significantly. Gastroscopy revealed reflux esophagitis and chronic non-atrophic gastritis. Ultrasound of the liver, gallbladder, pancreas and spleen showed that the wall of the cyst was thick and slightly rough, with poor internal sound transmission and dense light dots floating inside, suggesting the presence of chronic cholecystitis with gallbladder sediment-like stones. He was admitted to our department for further treatment.
II. Treatment history
After the patient was admitted to the hospital, routine blood tests were completed, and no anemia or other related complications were observed, and the patient and his family were explained the condition and feasible treatment methods. The patient’s family initially did not agree to the surgical treatment because of the patient’s age and diabetes, fearing that the patient would not be able to tolerate the surgery and that the incision would be difficult to heal after the surgery. However, after emphasizing with the patient and his family that gallstones of this type can easily induce complications such as pancreatitis and bile duct obstruction, and that medication is generally effective, and that minimally invasive surgery can be performed to reduce the patient’s postoperative recovery time, the patient agreed to undergo laparoscopic cholecystectomy after consideration. The gallbladder was removed intraoperatively, and postoperative cardiac monitoring was routinely given to monitor the patient’s vital signs. In addition, oral omeprazole enteric capsules were administered for the treatment of reflux esophagitis and chronic non-atrophic gastritis. And the changes of the patient’s condition need to be closely monitored during the drug administration.
III. Treatment results
The patient’s surgery went smoothly, and after returning to the ward safely, the vital signs were stable and the surgical incision healed normally, without the healing difficulties that the patient’s family feared. After 5 days of hospitalization, the patient was ready to be discharged and the indicators were reviewed, and the well returned to normal. The patient complained of the disappearance of the hidden pain in the upper abdomen, and his appetite basically returned to normal after surgery, but other digestive system diseases such as reflux esophagitis still required continued medication. One month after discharge from the hospital, the abdominal incision had completely healed.
IV. Precautions
After targeted treatment, the patient was very happy that his condition improved and met the discharge criteria, and I was also happy for the patient’s gradual recovery. Because of the patient’s history of diabetes, the patient was advised to have three regular meals in daily life and not to overeat, which would help to control the stability of blood sugar and also facilitate the recovery of the body after surgery. In addition, although the incision has recovered well, water should be avoided until the incision is completely healed to avoid inducing infection or affecting normal wound healing, and irritating foods, such as onions and scallions, should be avoided. Finally, if the incision is itchy, do not scratch it to avoid infection of the wound by injured germs.
V. Personal insight
Cholecystitis is mostly related to diet, irregular diet, overeating, and low daily water intake, all of which are closely related to the onset of cholecystitis, and the patient in this case is a typical counterfactual. Therefore, in order to prevent the occurrence of cholecystitis in daily life, the most important thing is to regulate their own dietary habits, to achieve regular meals, to maintain a balanced nutrition, try not to picky, partial food, do not eat too much greasy, fried food.