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Abstract: This shared case is a patient with secondary peritonitis. The patient was admitted with significant abdominal pain, palpable enlarged gallbladder with pressure pain in the right upper abdomen, accompanied by rebound pain and localized muscle tension, and CT of the upper abdomen suggesting cholecystitis and gallbladder stones. Based on the patient’s physical signs and ancillary examinations, secondary peritonitis was diagnosed, and laparoscopic cholecystectomy was given to resolve the primary disease as well as the secondary peritonitis. The patient’s symptoms disappeared after surgery and she recovered well.
Basic information】Female, 72 years old
Disease Type】Secondary peritonitis
Hospital】Jinzhou Central Hospital
Date of consultation】June 2022
Treatment plan】Surgical treatment (laparoscopic cholecystectomy) + intravenous drugs (meropenem for injection, ornidazole for injection)
Treatment period】7 days of hospitalization and regular follow-up
Treatment effect】Good recovery, cured, discharged from hospital
I. Initial consultation
It was an ordinary day shift, and I received a consultation request from the gastroenterology department, so I rushed to the gastroenterology ward. After briefly communicating with the gastroenterologist, I learned that the patient was admitted to the hospital with sudden onset of abdominal pain and completed some tests before admission.
The patient was examined and found to have significant abdominal pain with palpable enlarged gallbladder in the right upper abdomen with pressure pain, accompanied by rebound pain and local muscle tension, and secondary peritonitis was considered. After communicating with the patient and his family, we decided to transfer the patient to general surgery for treatment, and also suggested emergency surgical treatment according to his current actual condition. The patient and his family agreed to the treatment plan, and after the patient was transferred to our department, a ward was arranged for the patient.
II. Treatment process
After the patient was transferred to our department, we urgently improved the blood routine, coagulation function, electrocardiogram, blood type and other related preoperative tests, and contacted the operating room for preparation in an emergency. At present, the patient’s diagnosis was considered gallbladder stones with acute cholecystitis and limited peritonitis, and the peritonitis was secondary to peritonitis, thus requiring surgical treatment to remove the gallbladder.
Because of the patient’s age, laparoscopic cholecystectomy was recommended as a method with less surgical damage and faster postoperative recovery. After discussion with the patient’s family, they all agreed to undergo surgical treatment and signed the informed consent form for surgery.
During the operation, the gallbladder was seen to be gangrenous and under great tension, and exudate was seen around it. The gallbladder was surgically removed and sent for pathological examination. After surgery, the patient returned to the ward and was given anti-inflammatory treatment with injectable meropenem combined with injectable ornidazole. Seven days after surgery, the patient recovered well and was discharged from the hospital.
III. Treatment effect
The patient underwent surgical treatment to remove the lesioned gallbladder, which resolved the primary disease and thus the secondary peritonitis. Since the surgical procedure chosen by the patient was minimally invasive and less invasive, the patient resumed venting on the second postoperative day and gradually resumed eating without discomfort. The patient had no postoperative abdominal pain or distension, and the incision was aesthetically pleasing due to the minimally invasive surgery. 7 days after the incision was removed, the incision healed well and met the discharge criteria, so the patient was discharged from the hospital. Since the overall treatment process was relatively smooth, the patient and his family expressed satisfaction with the treatment.
IV. Notes
Through active treatment, the patient’s body recovered, and I felt very happy for the patient. The patient should also avoid greasy diet after surgery, because it takes some time to adapt after cholecystectomy, but the patient may easily have diarrhea and other conditions, so the family should properly regulate the patient’s gastrointestinal condition through diet. Patients should avoid exertion after surgery, enhance nutrition, eat more fresh vegetables and fruits, and eat less spicy, stimulating and greasy food. In addition, patients and their families should pay attention to the fact that they should come back to review the ultrasound examination of gallbladder and routine blood and biochemical examination at 1 month after surgery to monitor the recovery.
V. Personal insight
Secondary peritonitis is a relatively common abdominal disease in general surgery, mostly due to intra-abdominal organ lesions. In this patient, the gallbladder stone was embedded in the neck of the gallbladder, resulting in acute cholecystitis, and due to excessive tension of the gallbladder, causing gangrene of the gallbladder, which then led to secondary peritonitis. If surgery is not performed in a timely manner, there is a possibility of gallbladder perforation, and even pancystic peritonitis leading to intra-abdominal infection, resulting in infectious shock and endangering the patient’s life, but the patient was seen in a timely manner and the surgery was performed in a timely manner, so the recovery was smooth. This shows that the timing of surgery is particularly critical in the treatment of secondary peritonitis.