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Abstract: The subject of this case is an emergency patient who was admitted to the hospital with epigastric pain for 6 hours. Liver function tests performed in the emergency department suggested elevated transaminases and abdominal CT suggested intrahepatic bile duct stones. After admission, the patient was given laparoscopic hepatic left lobe resection under general anesthesia, and postoperative medication was given for symptomatic treatment. After treatment, the patient’s epigastric pain disappeared and the disease was cured.
Basic information】Female, 63 years old
Disease Type】Intrahepatic bile duct stones
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (laparoscopic hepatic left lobectomy) + medication (cefoperazone sodium for injection, diammonium glycyrrhizate for injection)
Treatment period】2 weeks of hospitalization
【Treatment effect】Symptoms of epigastric pain disappeared and the disease was cured
I. Initial consultation
The patient in this case visited the clinic for 6 hours with epigastric pain, accompanied by nausea and vomiting, and the nature of the pain was relatively intense. The patient reported that he had been suffering from upper abdominal pain for more than 10 years, and was diagnosed with chronic gastritis at a local clinic and given a gastric treatment plan. The emergency routine blood test indicated elevated blood picture, liver and kidney function indicated significantly elevated transaminases, and abdominal CT scan indicated intrahepatic bile duct stones, mainly concentrated in the left outer lobe of the liver. The patient’s condition was clearly diagnosed as abdominal pain caused by intrahepatic bile duct stones.
II. Treatment history
After admission, the patient was given intensive abdominal CT examination, which revealed that the left outer lobe of the liver was inflammatory and atrophic, and the intrahepatic bile ducts were dilated with a large number of stones, and the patient was given symptomatic treatment such as anti-infection with cefoperazone sodium for injection and liver protection with diammonium glycyrrhetinate for injection. At present, the patient’s intrahepatic bile duct stones were clearly diagnosed and mainly concentrated in the left outer lobe of the liver, and the preferred treatment option was laparoscopic left outer lobe hepatectomy under general anesthesia. The patient was discharged 2 weeks after the operation.
(Intensive CT examination of abdomen)
III. Treatment effect
The patient underwent laparoscopic surgery, which was less invasive, and the patient started to get out of bed on the 2nd postoperative day. On the 3rd postoperative day, there was defecation and bowel movement and started to eat a liquid diet. After eating, the symptoms of epigastric pain did not reappear, and the patient started to gradually increase his diet. The postoperative pathology suggested that the intrahepatic bile duct stones and the bile ducts showed chronic inflammatory changes, but no tumor and other lesions were seen. Therefore, the patient resumed normal activities and diet in 2 weeks of hospitalization and was discharged with cure.
IV. Notes
We are glad that the disease was cured after treatment, but after discharge, we should pay attention to more rest and avoid strenuous activities. In terms of diet, pay attention to a light and easily digestible diet, avoid eating greasy, spicy and stimulating food, and increase nutrition by eating more lean meat, milk, fish and shrimp, etc., and eat more fresh fruits and vegetables to supplement vitamins. About 1 month after the operation, it is recommended to return to the hospital for a review. The review items include: blood routine, liver function, to check whether the relevant indicators are normal, and review the abdominal CT to observe whether there is any residual infection in the abdominal cavity. If there are no special circumstances, it is recommended that the patient should be reviewed once a year, because hepatobiliary stones have a certain chance of recurrence.
V. Personal insight
The pathophysiology of intrahepatic bile duct stones is due to bile duct dilatation and bile duct infection caused by intrahepatic bile duct stenosis, resulting in the formation of stones. The most common clinical manifestations are abdominal pain and fever, but there are no special symptoms in the early stage of intrahepatic bile duct stones, and clinical symptoms are only shown when bile duct inflammation occurs. There is no special treatment for this disease in the early stage, and regular review is needed. If symptoms such as liver atrophy, bile duct dilatation, abdominal pain and fever appear, surgery should be performed as soon as possible. The patient in this case has a history of more than 10 years, and the early symptoms are mainly upper abdominal pain. At present, dilated intrahepatic bile ducts and biliary system infection are found and surgical treatment is given, and the treatment effect is good.