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Abstract: The patient presented with right upper abdominal pain with paroxysmal colic, accompanied by fever, vomiting and no diarrhea without any obvious cause 6 hours ago. Examination of the right upper abdomen was pressure pain without rebound pain, and Murphy’s sign was positive. Abdominal CT examination showed cholecystitis with stones in the body and neck of the gallbladder. The diagnosis of acute purulent cholecystitis with gallbladder stones was made, which was consistent with surgical signs, and trans-laparoscopic cholecystectomy under general anesthesia was performed, as well as anti-inflammatory treatment with antibiotics. He was hospitalized for 13 days with good wound healing.
Basic information】Male, 45 years old
Type of disease】Acute cholecystitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】February 2020
Treatment plan】Surgical treatment (trans-laparoscopic cholecystectomy) + medication (cefazoxime sodium for injection, sodium chloride injection)
Treatment period】Hospitalization for 13 days, review after 2 weeks, follow up for discomfort
Treatment effect】After treatment, abdominal pain was relieved and the wound healed well.
I. Initial consultation
The patient developed right upper abdominal pain with no obvious cause 6 hours ago, with paroxysmal colic, fever, anorexia, nausea and vomiting.
The vomit was not ejected, and there was no diarrhea, no urgency, no cessation of anal defecation, no malaise, and no discomfort.
He came to our hospital today without any treatment outside. Since the onset of the disease, the patient had poor sleep, poor appetite, no significant abnormalities in urination and defecation, and no significant weight loss. The abdomen was flat, no gastrointestinal pattern or peristaltic waves were seen, no varices in the abdominal wall veins, soft abdominal wall, right upper abdominal pressure pain, no rebound pain, positive Murphy’s sign, no enlargement of the liver and spleen, no mobile turbid sounds, no percussion pain in the liver and kidney area, normal intestinal sounds, and was initially admitted as gallbladder stone with cholecystitis.
II. Treatment history
The patient’s abdominal CT examination showed cholecystitis and stones in the body and neck of the gallbladder. Other ancillary tests were completed, mainly including routine blood, urine, liver and kidney functions, and the results were good and met the indication for surgery. After general anesthesia with tracheal intubation 3 days after hospitalization, routine catheterization was performed, and then trans-laparoscopic cholecystectomy was performed, which was relatively smooth, and the patient was sent to the ward after surgery and treated with intravenous drip therapy, the main drugs were cefazoxime sodium for injection and sodium chloride injection to prevent infection. One day after surgery, the abdominal cavity was continuously drained, and about 20 ml of light blood fluid was drained, and the incision was changed in time. Three days after surgery, about 18ml of pale yellow fluid was drained, the incision was changed, the abdominal drainage tube was removed without exudation, the pathological result was acute cholecystitis, and the treatment with antibiotic drugs was continued, and the condition was stable after 13 days of hospitalization, and the hospital could be prepared for discharge.
III. Treatment effect
The surgical operation was difficult, with intraoperative bleeding of about 20 ml, infusion of 1000 ml, removal of gallbladder for pathological examination, more satisfactory intraoperative anesthesia, and the patient returned to the ward safely after the operation. One day after the operation, the abdominal cavity was drained smoothly, and about 25ml of light blood fluid was drained, and the gauze at the incision was dry, without exudation and tenderness. About 18 ml of yellowish fluid was drained 3 days after the operation, and there was no exudation and light tenderness when the abdominal drainage tube was removed. Ten days after the operation, i.e. 13 days after hospitalization, the patient’s condition was stable, with normal body temperature, clear consciousness, mental health, diet and sleep, and normal urination and defecation. The abdomen was flat and soft, the stitches at the incision healed well, there was no exudation and tenderness, and the symptoms improved, so the patient could be discharged and reviewed after 2 weeks, and discomfort was followed up.
IV. Notes
The patient’s condition was stable after treatment, and I was sincerely happy for the patient. I instructed the patient to pay special attention to the observation of abdominal drainage after discharge, especially the color of abdominal drainage fluid, and also the need to pay attention to whether the drainage tube has fallen off. The incision site should be clean and dry, and the patient should be encouraged to get out of bed in an appropriate amount to help prevent intestinal obstruction. In addition, patients are advised to eat less and more often, avoid spicy and hard foods, try to eat light and easily digestible foods, and pay attention to their diet after going home, and seek medical consultation promptly in case of discomfort.
V. Personal insight
Acute cholecystitis may be caused by stones damaging the mucosa, and most patients will have pain in the right upper abdomen or epigastrium, usually in the form of colic or continuous pain, which may cause complications such as gallbladder perforation, biliary bleeding, and chronic cholecystitis if left untreated. For the patient in this case, after the pain appeared for 6 hours, she went to the hospital in time, and after the corresponding examination to clarify the disease, she underwent surgery in time, and although the procedure was difficult, the surgery was relatively smooth and the prognosis was better. Therefore, when the right abdominal pain appears, do not take it seriously, but go to the hospital in time to avoid delaying the treatment of the disease.