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Abstract: The patient was admitted to the hospital with abdominal pain and fever, and was diagnosed with common bile duct cyst after abdominal CT examination, and underwent choledochal cystectomy + bile-intestinal anastomosis, which was confirmed by postoperative pathology to be a common bile duct cyst without malignant transformation. Choledochal cyst is a congenital disease, which generally manifests as cystic dilatation of the common bile duct. The main clinical manifestations include epigastric pain, fever and other symptoms, and abdominal ultrasound and abdominal CT examination both indicate cystic dilatation of the common bile duct.
Basic information】Female, 26 years old
Disease Type】Choledochal cyst
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Medication (cefoperazone sodium sulbactam for injection + diammonium glycyrrhizate injection) + resection of common bile duct cyst + biliary enterostomy
Treatment period】2 weeks of inpatient treatment, 1 month of outpatient review
Treatment effect】The epigastric discomfort disappeared, the surgery was radical, and the postoperative recovery was smooth.
I. Initial consultation
The patient was seen for sudden onset of epigastric pain with fever. The abdominal pain lasted for 1 day, and the fever was accompanied by generalized shaking, and the temperature reached 39℃, accompanied by malignancy and vomiting. In the emergency room, routine blood tests and liver function were performed. Routine blood tests indicated elevated blood picture, and liver function indicated significantly elevated bilirubin and transaminases, suggesting biliary infection.
II. Treatment history
At present, the patient had biliary tract infection. After admission, the patient was given anti-infective treatment with cefoperazone sodium sulbactam sodium by injection and liver-protective treatment with diammonium glycyrrhizate injection. Further improvement of intensive abdominal CT examination revealed that the patient had cystic dilatation of the common bile duct throughout, with a maximum diameter of about 4 cm, smooth common bile duct wall, and no obvious tumorigenic occupancy was seen. At present, choledochal cyst can be diagnosed, but this disease is often congenital and prone to malignant transformation, and the treatment plan is preferred to surgically remove the choledochal cyst. The patient’s family agreed to the surgery, and the patient underwent choledochal cystectomy + biliary enterostomy under general anesthesia.
III. Treatment effect
The patient’s choledochal cyst was completely detached during the operation, and the pathology confirmed that the choledochal cyst was not malignant. At present, the patient’s choledochal cyst can be considered as a radical resection and there is no risk of recurrence. The patient started to get out of bed on the 3rd postoperative day, defecated and started to eat on the 4th postoperative day, and the symptoms of discomfort in the right upper abdomen gradually disappeared on the 5th postoperative day, and the liver function also gradually returned to normal, the patient’s condition was stable and he was discharged at 2 weeks of hospitalization.
IV. Notes
We are glad that the patient’s condition has improved after treatment. We suggest that the patient should pay more attention to rest after discharge, and focus on a light diet, gradually increasing nutrition and food intake. One month after the operation, the patient should return to the hospital for a follow-up examination, which mainly includes blood routine, liver function and abdominal CT examination to see if the patient has any abnormal liver function, abdominal infection and abdominal fluid at present. If there are no special circumstances, the review can be delayed to once every 1 year. Since the patient has undergone biliary-intestinal anastomosis, the normal physiological anatomy has been changed, and it is easy to have intestinal fluid reflux into the bile duct, which leads to biliary system infection and can lead to fever, so if chills and fever occur, the patient should return to the hospital for review in a timely manner.
V. Personal insight
Choledochal cyst, also known as congenital bile duct dilatation, is a congenital disease, related to congenital development. The cyst is prone to biliary system infection, and repeated inflammatory stimulation will lead to bile duct malignancy, thus seriously affecting the life and health of the patient. If there is epigastric pain and fever, we should consult a doctor in time, and if the diagnosis of common bile duct cyst is confirmed, we should operate as soon as possible. In this case, the patient received surgery after the discovery of common bile duct cyst, and the postoperative pathology also confirmed that there was no malignant change, and obtained a very good treatment effect.