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Abstract: The patient had a 20-year history of chronic hepatitis B and a 5-year history of cholecystitis, which was not treated. He was given long-term oral antiviral treatment with entecavir capsules, but did not adhere to them, and was not reviewed during the interval of 1 year, and came to our hospital. A small amount of bile echo could be seen, and the abdominal distension was relieved.
Basic information】Female, 66 years old
Type of disease】Acquired gallbladder agenesis
Hospital】988th Hospital of the PLA Joint Security Force
Date of consultation】June 2021
Treatment plan】Medication (anti-inflammatory and biliary tablets + ursodeoxycholic acid capsule + compound glycopyrrolate tablets) + dietary guidance
Treatment Period】Outpatient treatment for six months, regular follow-ups
Results】Gallbladder atrophy is better than before, a small amount of bile echo is visible, abdominal distension is relieved
I. Initial consultation
Auntie Zhang said she had a 20-year history of chronic liver disease, and her condition was relatively stable. 5 years ago, she was found to have cholecystitis, and the doctor prescribed entecavir capsules, but she did not insist on eating them. The patient was diagnosed with acquired gallbladder agenesis because the ultrasound examination suggested gallbladder agenesis and further CT examination of the upper abdomen revealed an atrophied gallbladder shadow in the gallbladder fossa.
II. Treatment history
The patient was diagnosed with acquired gallbladder agenesis, because the patient had a history of cholecystitis for 5 years and was in a state of progressive atrophy progression. In order to prevent cancer, surgical removal was recommended, but the patient’s family requested temporary conservative treatment for six months after discussion, and then removal after medication was ineffective. After 1 month of oral administration, the patient was switched to ursodeoxycholic acid capsules for biliary benefit. The patient was also instructed to drink more warm boiled water, 1500-2000ml per day, eat more fresh vegetables and fruits, and avoid greasy and spicy food intake; since bile is produced by liver cells, liver protection should be strengthened and compound glycyrrhetinic acid tablets were given orally.
III. Treatment effect
After half a year of treatment, the patient came to the hospital to review the ultrasound: bile echogenicity was visible in the gallbladder, the volume of the gallbladder was 3.5cm×1.8cm, and the wall was slightly thick. The results were better than before, the treatment was effective, and the abdominal distension symptoms were relieved, the physical strength was also significantly enhanced, and there were no too obvious discomfort symptoms when eating a little greasy food occasionally. The patient and his family were especially happy that there was no need for surgery for the time being. They continued to take oral ursodeoxycholic acid capsules and compound glycyrrhizin tablets to protect the liver and improve the bile, and continued to adjust the drinking water and dietary principles.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. We remind the patient that even though the condition has improved and he is free from surgery, the gallbladder is still small after all, the gallbladder wall is still somewhat thick, and the gallbladder inflammation is not completely relieved, so we should pay attention to the following.
1, daily life to avoid eating greasy, indigestible food, such as fatty meat, cakes, animal offal, barbecue and other foods to avoid aggravating the inflammation of the gallbladder.
2, eat more vegetables and fruits, drink more water, do not replace plain water with noodle soup, carbonated drinks and dairy products, eat in moderation, eat less and more often, avoid overeating.
If the gallbladder atrophies again, it is still recommended to remove it surgically to avoid the risk of cancer.
V. Personal insight
Through understanding the patients in this case, we can know that chronic cholecystitis and gallbladder stones are more common in daily life, while some young people suffer from cholecystitis, gallstones and gallbladder polyps because they often skip breakfast and eat irregularly, and they hesitate between removing or not removing the gallbladder. All in all, the general population is reminded to love their bodies, eat three meals on time and in the right amount, eat more vegetables and fruits, and avoid the stimulation of long-term tobacco, alcohol, strong coffee, strong tea and greasy food to promote health.