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Abstract: The patient in this case is a 56-year-old woman who presented to our hospital 4 days ago with vague abdominal pain, nausea, vomiting and other uncomfortable symptoms that did not improve, so she came to our hospital. After emergency examination, the preliminary diagnosis was right kidney stone, and the diagnosis was confirmed after admission to the hospital for perfect examination. She was treated with surgery to remove the stone and improve the symptoms.
Basic information】Female, 56 years old
Disease Type】Kidney stone
Hospital】The First Hospital of China Medical University
Consultation time】June 2019
Treatment plan】Surgical treatment (fiberoptic flexible nephrolithotomy) + medication (levofloxacin hydrochloride injection)
Treatment period】1 week of hospitalization, 3 months of outpatient follow-up
Treatment effect】Kidney stone removed, abdominal pain and vomiting disappeared
I. Initial consultation
The patient, a 56-year-old female, complained of intermittent vague pain in the right lower abdomen with no obvious cause 4 days ago, accompanied by nausea and vomiting twice, with a tendency to eject, and the vomit was stomach contents. The report of routine urine examination indicated that there were homogeneous red blood cells and crystals in the urine, and the abdominal ultrasound indicated mild hydronephrosis in the right kidney, right kidney stone, and mild dilatation of the right upper ureter, so he was admitted to the emergency room.
II. Treatment
After admission, the abdominal CT examination was completed, suggesting right ureteral upper segment stone, mild hydronephrosis and right kidney stone. After communicating with the patient and his family about his condition, we decided to perform fiberoptic nephrolithotomy. The operation was performed under general anesthesia, and the operation went smoothly without significant bleeding. After the patient returned to the ward safely, secondary care was given, and his vital signs were closely monitored. Levofloxacin hydrochloride injection was applied to prevent infection, and the urethral orifice was wiped with iodophor cotton balls regularly.
III. Treatment effect
After surgery, the patient’s right kidney and ureter were completely cleared of stones, and he could move around indoors on the second postoperative day, and recovered well.
IV. Notes
The patient successfully removed the stone during the operation and followed the doctor’s instruction to keep the perineal area clean after the operation. After 7 days of hospitalization, the patient’s discomfort disappeared, and I was very glad to learn that he could be discharged and his face was free from the pain he suffered before the operation. I also reminded the patient that the stone was a water calcium oxalate stone, so the postoperative diet should be less oxalic acid-rich foods, such as cabbage, spinach, oleaginous vegetables, strong tea, etc., and calcium-rich foods, such as dairy products, shrimp, etc. In addition, after the healing of hydronephrosis, the amount of water should be increased to prevent the recurrence of kidney stones; in addition, if there is abdominal pain, vomiting and other uncomfortable symptoms after surgery, you should follow up promptly.
V. Personal insight
Kidney stone is a relatively common urinary system disease, but should also be taken seriously, if similar to the patient in this article, abdominal pain, accompanied by visible hematuria, nausea and vomiting and other symptoms, should be highly alert to kidney stones, and as soon as possible to seek medical advice, according to the size and location of their own stones, choose the appropriate method to follow medical advice to discharge kidney stones, to relieve discomfort, if the kidney stones are small patients can also be conservative treatment, and regular follow-up. Patients with small kidney stones can also be treated conservatively and have regular follow-ups.