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Abstract: This patient was found to have gallbladder stones combined with acute cholecystitis 1 week ago, and did not receive early surgical treatment due to family obstruction, but only conservative treatment, but the effect was poor. Through physical examination and abdominal CT, the diagnosis of gallbladder perforation was made clearly. After treatment, the patient’s systemic infection was controlled and his symptoms disappeared, and he was discharged successfully.
Basic information】Male, 60 years old
Disease Type】Gallbladder perforation
Hospital】Liaocheng People’s Hospital
Consultation time】November 2021
Treatment plan】Surgical treatment (gallbladder puncture and drainage, abdominal puncture and drainage) + drug treatment (cefoperazone sodium for injection, hydroxyethyl starch sodium chloride injection)
Treatment period】1 month hospitalization
Effectiveness】The patient’s systemic infection was controlled, symptoms disappeared, and he was discharged successfully.
I. Initial consultation
The patient was an elderly male who presented with symptoms of fever and reported total abdominal pain. The patient’s medical history revealed that the patient was found to have gallbladder stones combined with acute cholecystitis 1 week ago, and had been treated conservatively in a local hospital because his family did not accept surgery to remove the gallbladder. On the day of the visit, the symptoms of abdominal pain were worse than before and were accompanied by fever, and the patient’s family felt that his condition had worsened and came to the clinic. By observing the patient’s symptoms and signs, a gallbladder perforation was initially considered. Subsequently, the patient was advised to review the abdominal CT, which suggested gallbladder perforation and also revealed diffuse and multiple abscesses in the abdominal cavity. The blood count suggested a severe infection, and the patient was admitted to the intensive care unit.
II. Treatment history
After admission, the patient’s general condition was very poor, with a rapid heart rate and low blood pressure, which were signs of infectious shock. At present, the most important thing is to solve the problem of infection, because the abdominal abscess is caused by the spread of pus from the perforated gallbladder, and the main task is to perform gallbladder puncture and laparotomy drainage to drain the pus. Then cefoperazone sodium for injection was given to anti-infection, and hydroxyethyl starch sodium chloride injection and saline were infused to rehydrate against shock. The patient’s family agreed with the current treatment plan, so the patient underwent gallbladder puncture under ultrasound guidance, and the abdominal abscess was punctured, and a total of about 2000 mL of pus was drained. 2 days after the puncture, the pus was gradually drained, and the patient’s general condition began to gradually improve, the blood picture began to decrease, and the patient’s mental and physical strength gradually improved.
III. Treatment effect
For patients with gallbladder perforation combined with severe infection, the main problem is to solve the infection problem. After the perforation, the pus is drained, and the patient’s condition will gradually improve. First of all, the patient’s blood picture, as well as PCT and CRP, began to decrease, and mental strength also began to recover. On the third day after the operation, the body temperature gradually returned to normal, and the abdominal discomfort gradually disappeared, and the patient gradually ate and increased nutrition. After one month of hospitalization, the patient’s systemic infection was controlled and the symptoms disappeared, and he was discharged successfully.
IV. Notes
We are glad that the patient’s condition was controlled after treatment. However, after discharge, the patient still needs to keep the drainage of the gallbladder puncture and drainage tube open and pay attention to regular review. If, after going home, symptoms of fever appear, it may be that some residual infection in the abdominal cavity continues to suppurate, and prompt medical attention is needed to confirm whether another follow-up treatment is required. Eat a light, nutritious and easily digestible diet and avoid spicy, stimulating and cold foods. Learning to regulate emotions is also important to the recovery of the disease.
V. Personal insight
Gallbladder stones combined with acute cholecystitis, mostly manifested as sudden abdominal pain, should receive formal treatment, i.e. cholecystectomy, as soon as possible. If gallbladder stones and acute cholecystitis continue to worsen without relief, it may cause septicemia and gangrene of the gallbladder, or even gallbladder perforation. Once the gallbladder is perforated, the purulent fluid in the gallbladder spreads into the abdominal cavity causing an abdominal abscess, which causes the spread of infection and aggravates it, endangering the patient’s life and causing the disease to become more complicated. Therefore, this case can warn us that the presence of gallbladder stones combined with acute cholecystitis should be treated early with the doctor for targeted treatment to avoid the occurrence of related complications.