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Abstract: The patient sought medical attention for epigastric pain, nausea, vomiting and other symptoms, and was diagnosed with pseudocyst after examination, clinical disease pseudocyst is relative to true cyst, pseudocyst is no real cyst wall, because of the accumulation of exudate inside the abdominal cavity, wrapped by the surrounding tissue to form an encapsulated effusion, in which mostly pancreatic pseudocyst is common, the patient after debridement and drainage + drug treatment, the condition has been controlled, the patient is improving. All indicators are improving.
Basic information】Female, 52 years old
Disease Type】Pseudocyst
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】January 2022
Treatment plan】Surgical treatment (ultrasound endoscopic positioning transgastric access pancreatic pseudocyst opening and drainage) + drug treatment (injectable growth inhibitor, metronidazole injection)
Treatment period] 14 days of hospitalization and 1 month of outpatient follow-up
Treatment effect】The condition has been controlled, and all indicators are improving
I. Initial consultation
A few months ago, Ms. Cao came to me at the outpatient clinic with occasional abdominal pain and distension. I observed the overall condition of the patient and found that she was still in good spirits, slightly emaciated, with a clear will, so I started to ask for details. The patient was about 50 years old and had acute pancreatitis more than a month ago. After treatment at an outside hospital, her condition improved, but now she still felt occasional abdominal pain and distension, so she came to the clinic. After that, I performed an initial examination of the patient and prescribed MRI consultation for further examination. The patient’s vital signs were normal, the abdomen was flat and soft, with light pressure pain in the middle and upper abdomen, and a mass could be found in the upper abdomen or left quarter rib area, without rebound pain and muscle tension. The lesion compressed the main pancreatic duct, resulting in a heterogeneous dilatation of the pancreatic duct in the distal pancreatic tail. The patient had a previous history of pancreatitis and no history of drug allergy. He was initially diagnosed as acute interstitial edematous pancreatitis complicated by pseudocysts, and was admitted to the hospital.
(MRI)
II. Treatment history
After admission, the patient continued to improve routine blood tests, blood glucose, lipids, liver and kidney function, coagulation function, electrolytes, C-reactive protein, etc. The results showed persistent elevation of serum amylase and elevated leukocytes, and to further confirm the diagnosis, CT and enhancement of the upper abdomen were performed. After clinical examination and diagnosis, Ms. Zhou was finally diagnosed with pancreatic pseudocyst, so symptomatic treatment was carried out immediately. After preoperative preparation and interventional treatment, after communication with the patient and the patient’s family, ultrasonic endoscopic localization of transgastric access pancreatic pseudocyst opening and drainage was performed on the 5th day of admission, and the procedure was smooth. After the operation, the patient had no discomfort. After the operation, the patient’s vital signs were monitored, gastrointestinal decompression was placed, water was fasted for 48 h, and acid- and enzyme-suppressing drugs, i.e., growth inhibitor for injection, metronidazole injection for anti-infection, and rehydration and nutritional support were given.
III. Treatment effect
The patient was admitted to the hospital after being diagnosed with pancreatic pseudocysts. After admission, the patient cooperated with the doctor for active and effective symptomatic treatment, and underwent ultrasonic endoscopic localization of transgastric access pancreatic pseudocyst opening and drainage, and was treated with acid suppression, enzyme suppression, and anti-infection, etc. The patient felt significant relief of abdominal distension, and there was no There was no postoperative bleeding, infection or other complications. After 9 days of continued treatment, the upper abdominal CT was rechecked and the cyst was significantly smaller than before, and the patient was discharged after evaluation. After discharge, the patient followed the doctor’s prescription and took medication on time. After 1 month of outpatient review, the patient’s condition was significantly improved, his spirit was fine, his face was ruddy, his consciousness was clear, and he reported no obvious abdominal pain and distension, fever, etc. The patient’s prognosis was good and he was still under follow-up. The patient had a deeper understanding of the disease through this illness, and the patient as well as his family were satisfied with this treatment.
IV. Notes
We are glad that the patient is improving after the treatment, the following points should be noted by the follow-up patient.
1.After the treatment, the patient should follow the doctor’s advice, take the medicine on time, review regularly, and contact the doctor immediately if there is abdominal pain, abdominal distension and other uncomfortable symptoms, and seek medical consultation immediately. Pseudocysts are prone to recurrence and patients should pay attention to avoid infection, bleeding, etc. If they appear, seek immediate medical attention.
2.If the patient is discharged with drainage tube, pay attention to keep the drainage tube unobstructed and return to the hospital promptly in case of blockage. The skin around the drainage tube should be kept clean and hygienic. Regular review and replacement of medications and drainage bags after discharge.
3. In daily life, pay attention to a low-fat or fat-free diet, which allows for easily digestible food, enhanced nutrition, regular diet, and guaranteed fluid intake.
4.After discharge, pay attention to bed rest, beware of bedsores during the period, turn and pat the back regularly, pay attention to protecting the wound when coughing, if vomiting symptoms appear and vomiting is violent, you can temporarily fast, pay attention to rehydration and bed rest. Exercise moderately according to the situation, but not strenuously, adjust the lifestyle, pay attention to the quality of personal rest, adjust personal emotions, and accompany family members more.
V. Personal insight
Pancreatic pseudocyst is a complication secondary to acute and chronic pancreatitis, trauma or postoperative pancreatic surgery. It is formed by the overflow of blood, exudate or pancreatic fluid, and the surrounding tissue fibers proliferate and wrap the fluid around it, and because it is caused by inflammatory stimulation that the fibrous tissue proliferates and wraps around it, the wall of the cyst does not have pancreatic epithelial cells, so it is called pseudocyst. The clinical manifestations of pancreatic pseudocysts are not specific, mostly presenting with epigastric pain, nausea, vomiting and weight loss, and a few combined with jaundice, wasting and upper gastrointestinal bleeding. In daily life, the preventive measures for pancreatic pseudocysts are as follows.
1, the correct understanding of the occurrence of the disease, especially for the disease without specific symptoms should pay more attention to prevent the cause of major diseases. In life, people should not ignore the disease, especially for some minor pains and aches, to achieve regular medical checkups, early detection and early treatment.
2, after drainage surgery, patients need to rest in bed for 24 hours, with acute pancreatitis patients should be fasting, parenteral nutrition, with chronic pancreatitis can eat a liquid or semi-liquid diet. Regularly review endoscopy, follow the doctor’s orders, take medication on time, and seek medical advice if there is discomfort.
3, daily life pay attention to a light diet, avoid fried food, quit smoking, quit drinking, avoid spicy stimulating cold food, eat more fruits and vegetables, reasonable diet, recovery after the disease pay attention to rest, avoid exertion, maintain adequate sleep, early to bed and early to rise.
4, no matter what kind of disease patients, will be nervous fear of their disease can not be cured, or will not evolve into a more serious disease, fear of disease, making their own depression, negative negative emotions, these emotions are not conducive to the treatment and recovery of the disease, so family members to calm the patient’s emotions, help patients to build confidence to overcome the disease, while exhorting patients, and actively cooperate with the doctor’s treatment, for Early recovery.