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Abstract: A middle-aged male patient was admitted to the hospital due to abdominal pain and distension with nausea, vomiting, and unvented bowel movements without obvious causative factors, and was diagnosed with duodenal obstruction after relevant investigations, combined with symptoms and signs and medical history. The patient was admitted to the hospital, and after 1 week of gastrointestinal decompression, correction of water-electrolyte and acid-base balance, the patient’s abdominal pain and abdominal distension disappeared, and he resumed defecation and was discharged.
Basic information】Male, 42 years old
Disease Type】Duodenal obstruction
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】December 2021
Treatment plan】Gastrointestinal decompression + correction of water-electrolyte and acid-base balance (glucose sodium chloride, potassium chloride, compound amino acid injection) + anti-infection (ceftriaxone sodium, metronidazole sodium chloride injection) + enema treatment
[Treatment period] 1 week of hospitalization, 1 month and 3 months after returning to the hospital for review
Effectiveness】The patient’s abdominal pain and bloating disappeared, and he resumed normal diet and was discharged from the hospital.
I. Initial consultation
A middle-aged male patient came to the outpatient clinic, covering his stomach with a painful expression. The patient complained of abdominal pain and bloating without obvious cause for one day, nausea and vomiting for one time, and no defecation. The patient was asked to lie flat on the treatment bed for specialist examination. The patient was lying flat on the treatment bed with his hips and knees flexed, the abdomen was slightly distended, no intestinal pattern or gastrointestinal peristaltic waves were seen, the abdomen was soft, periumbilical and left lower abdominal pressure pain was obvious, no significant rebound pain, no abnormal mass was palpated, no bulging sounds on percussion, negative mobile turbid sounds, and diminished bowel sounds. Therefore, the patient was initially admitted to the hospital with the diagnosis of “duodenal obstruction” and was hospitalized for further examination and treatment.
II. Treatment process
After admission, we inquired about the patient’s medical history in detail and learned that the patient had been diagnosed with gastric tumor 10 years ago and had undergone a major gastrectomy with good results. The patient was then allowed to undergo further examinations, such as hematocrit analysis, abdominal X-ray, and electrocardiogram, etc. The results showed that the leukocyte and hemoglobin counts were increased, which might be related to the water loss in the patient’s body. Since the patient explicitly refused surgical treatment, conservative treatment was decided, including gastrointestinal decompression, correction of water-electrolyte and acid-base balance, and prevention of infection. If conservative treatment was ineffective, intestinal adhesion release was then proposed. The patient was first given a nasogastric tube for gastrointestinal decompression, followed by intravenous sodium glucose chloride injection, potassium chloride injection and compound amino acid injection, etc. After correcting the water-electrolyte balance, ceftriaxone sodium and metronidazole sodium chloride injection were given to prevent infection. After 1 day, the patient’s symptoms were slightly relieved, but he did not pass stool, so he was given an enema. 2 days later, the patient’s abdominal pain and bloating disappeared, and a liquid diet was ordered. After 1 week of hospitalization, the patient improved and was discharged, and was asked to come back to the hospital for review in 1 month.
III. Treatment effect
After 1 week of hospitalization, the patient’s abdominal pain, abdominal distension, nausea and vomiting disappeared, and he resumed normal diet and defecation, and the relevant indexes also returned to normal level. The patient was instructed to review the routine blood and electrolytes at the outpatient clinic one month after discharge, and to return to the hospital to review the gastroscopy in three months.
IV. Precautions
The patient’s health improved significantly after the treatment, and as the attending physician, we are truly happy for him. In daily life, patients should pay attention to dietary hygiene, wash their hands before and after meals, and keep their bowels open to avoid constipation. It is important to eat foods high in vitamins, not spicy foods, raw and hard foods, and foods that are difficult to digest. Eating more green vegetables and fruits will help keep the bowels open and conducive to intestinal health. Do not overeat, otherwise it is easy to increase the burden on the gastrointestinal tract, which is not conducive to gastrointestinal health. Also pay attention to quit smoking and alcohol, keep a happy mood.
V. Personal insight
Because duodenal obstruction not only makes the intestinal cavity mechanically inaccessible, but also accompanies local blood circulation disorder, which can lead to severe abdominal pain, vomiting or shock, etc. The onset is rapid, the course of the disease develops rapidly, and the mortality rate is high if the treatment is not timely. Therefore, people with a history of gastrointestinal surgery, trauma or constipation should pay attention to regular review, maintain good personal habits, do not stay up late, combine work and rest, exercise appropriately, and observe bowel movements so that gastrointestinal diseases can be detected early.