(Disclaimer: This article is only for popular science purposes, and the information in the following content has been processed to protect Auntie Zhang’s privacy)
Abstract: Auntie Zhang had sudden onset of abdominal pain more than 3 hours ago, and the abdominal pain gradually worsened to persistent pain in the right mid-upper abdomen, accompanied by nausea and vomiting once, with fever and yellow sclera, and was seen in the emergency department. Auntie Zhang was given routine blood, biochemical and ultrasound examinations, and was initially diagnosed with common bile duct stones, a common biliary tract disease. She was given laparoscopic choledochotomy for stone extraction, cholecystectomy and anti-infection treatment, and her abdominal pain was relieved, jaundice subsided and her condition gradually recovered.
Basic information】Female, 53 years old
Disease Type】Choledocholithiasis, obstructive jaundice, cholangitis
Hospital】Beijing First Hospital of Integrative Medicine
Date of Consultation】May 2021
Treatment plan】Surgical treatment (choledochotomy for stone extraction, cholecystectomy) + intravenous infusion (injectable sodium lasix cephalosporin, glucose sodium chloride injection)
Treatment period】Hospitalization for 10 days, regular review
Treatment effect] Abdominal pain relieved, jaundice subsided, condition gradually recovered
I. Initial consultation
Auntie Zhang is 53 years old, usually in good health, no diabetes, hypertension, coronary heart disease and other chronic diseases, regular diet, normal urine and stool, and good sleep. More than 3 hours ago, Auntie Zhang suddenly felt pain in her right upper middle abdomen, which became more and more serious, and she had nausea, vomiting and fever, so she was seen in the emergency department. She was diagnosed with common bile duct stone, obstructive jaundice and cholangitis, and was recommended to be hospitalized.
II. Treatment process
After Auntie Zhang was admitted to the hospital, she was given anti-infection treatment with sodium laxative cephalosporin for injection, rehydration with sodium chloride glucose injection, and bile duct MRI was done to confirm the diagnosis of common bile duct stones, considering surgery as the only way to cure common bile duct stones. After explaining her condition, she underwent laparoscopic choledochotomy and cholecystectomy, and the operation went well. After the surgery, Auntie Zhang was given sodium cephalosporin for injection and fasted with water. After the exhaustion, she was instructed to eat a light diet, starting with a liquid diet and gradually transitioning to a normal diet, and the postoperative wound was disinfected and changed regularly. Because an abdominal drainage tube was placed, the amount of drainage was recorded daily and the color of the drainage fluid was observed.
III. Treatment effect
Auntie Zhang recovered well after the operation. Due to the minimally invasive surgical method, she could get out of bed properly on the first day after the operation. Three days after surgery, she resumed defecation, and her gastrointestinal function was restored. On the 5th postoperative day, the normal diet was already in place and the infusion of fluids had been completely stopped. 7 days after surgery, the sutures were removed. Ten days after the operation, the abdominal drainage tube was removed and Auntie Zhang was discharged from the hospital to recuperate. After 1 month of postoperative follow-up, Auntie Zhang had no abdominal pain and bloating, no diarrhea, jaundice subsided, and her condition had gradually recovered.
IV. Notes
We are glad that Auntie Zhang’s symptoms have been relieved, but we still need to advise that dietary recovery needs to start from a liquid diet, semi-liquid diet, you can eat millet porridge, pumpkin porridge and other easily digestible food, if there is no abdominal distension and nausea and other discomfort, you can gradually transition to a normal diet, and a low-fat diet, do not eat fatty meat, doughnuts, cream and other greasy food. In addition, you should relax, do not work hard, do not stay up late, and usually exercise properly to enhance your physical fitness.
V. Personal insight
After the occurrence of common bile duct stones, Auntie Zhang is able to tolerate surgical treatment, so she will give priority to surgical treatment, which requires surgical removal of the stones. If the stones are not surgically removed, the common bile duct stones will lead to biliary obstruction, bile excretion will be obstructed, which will further lead to obstructive jaundice, and bacteria will proliferate, causing acute obstructive purulent cholangitis, and the patient may experience severe abdominal pain, and also fever, In severe cases, it can lead to infectious shock, which can be life-threatening.