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Abstract: A 38-year-old male patient with intrahepatic bile duct stones was found 10 years ago, at that time the stones were small and had no obvious symptoms. Later, he came to our hospital with epigastric discomfort. The examination results indicated that the patient’s liver tissue was atrophied and there might be a risk of cholangiocarcinoma if it progressed further.
Basic information】Male, 38 years old
Disease Type】Intrahepatic bile duct stones
Hospital】Xiehe Hospital of Fujian Medical University
Date of Consultation】October 2020
Treatment Plan】Left hepatectomy
Treatment Period】1 month of inpatient treatment and 2 years of outpatient follow-up
Effectiveness】The patient had good overall recovery and no recurrence
I. Initial consultation
The patient found intrahepatic bile duct stones 10 years ago, the stones were small at that time, no obvious symptoms, the doctor said after the consultation that it was not too important, regular review can be done. The patient was reviewed for 2-3 years with no change, and later stopped paying attention to it and did not even review it, completely ignoring it. In the previous period, he would also pay active attention to diet regulation, exercise and lifestyle improvement, but found that there was not much change for 2-3 years, so he thought it did not matter. As a result, recently a vague feeling of discomfort in the upper abdomen appeared, especially after a full meal or eating fatty food, and I felt that my eyes and urine were a little yellow, so I rushed to the hospital for consultation. On the first visit, he was given liver function and hepatobiliary CT tests, and it was found that the bilirubin was mildly elevated, and the CT indicated that the entire left hepatic bile duct was significantly dilated and the liver tissue was atrophied.
II. Treatment history
In view of the current atrophy of the left liver, intrahepatic bile duct stones with symptoms, and the risk of bile duct cancer could not be completely excluded, the patient was recommended to undergo surgical resection. The patient agreed. Subsequently, during surgery, it was found that the patient’s left liver was atrophied and hardened, and a large amount of pus had accumulated in the bile ducts, and the possibility of bile duct cancer could not be ruled out. Since the number of stones was not large, but for insurance purposes, a left hepatectomy was performed with a slightly larger scope than benign disease, so that a better treatment effect could be obtained in case of bile duct cancer.
III. Treatment results
The patient recovered smoothly after the operation and there were no complications. The symptoms of intrahepatic bile duct stones were relieved and the patient had good overall recovery. Patients were advised to pay attention to keep the incision area clean and dry to avoid infection. Postoperatively, in combination with the patient’s own better constitution, the incision was therefore not infected, but just took longer to heal.
The pathological result of the patient was early bile duct cancer, which was very fortunate for the patient. Due to the large extent of resection during the previous surgery of intrahepatic bile duct stones, the early cancer of the patient in this case was probably curable and the postoperative result was good, and the patient was discharged after 1 month of hospitalization. The patient was discharged after 1 month of hospitalization. After discharge, the patient had regular review for about 2 years and no recurrence of intrahepatic bile duct stones had occurred, and no signs of cancer recurrence were found.
IV. Notes
The patient was fortunate to have undergone surgery in time after the diagnosis of intrahepatic bile duct stones, and the early cancer foci were removed together with the hepatectomy procedure under unknown circumstances. However, it is recommended that the patient should pay attention to eating more fresh vegetables and fruits, more low-fat and high-protein food, and less greasy food in daily life after discharge from the hospital. After the operation, the patient can be appropriately active according to the situation, and it is generally recommended that strong physical exercise should be carried out after 2-3 months to help enhance his physical fitness.
V. Personal insight
Intrahepatic bile duct stones can be complicated with cholangiocarcinoma, and can also have similar symptoms with early cholangiocarcinoma. In this article, after the patient experienced upper abdominal discomfort and felt a little yellow in her eyes and urine after eating greasy food, she finally became alert and sought timely medical consultation and early treatment to avoid further development of the disease.
Therefore, it is recommended that we should not ignore the disease because it is small, certain diseases will be gradually aggravated by delayed treatment and will not show symptoms, when there are symptoms, it often means that the disease enters a serious stage, especially the liver; but we should not be anxious because of certain small symptoms, most small intrahepatic bile duct stones may only be calcified foci in the liver, the probability is that they will not cause too much impact, causing such serious consequences with The patient’s physique and bad habits are related.