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Abstract: The patient was admitted to the hospital with a sudden onset of subxiphoid pain for 6 hours. He reported that he had been suffering from discomfort in the cardiac fossa for many years, and the local clinic diagnosed it as a stomach disease, so he had been treated according to the stomach disease with moderate effect. After anti-infection and hepatoprotective treatment and laparoscopic hepatic lobectomy under general anesthesia, the patient’s liver function returned to normal and the subxiphoid pain disappeared.
Basic information】Female, 68 years old
Disease Type】Intrahepatic bile duct stones combined with infection
Hospital】Liaocheng People’s Hospital
Date of Consultation】November 2021
Treatment plan】Medication (cefoperazone sodium for injection + diammonium glycyrrhizate enteric capsule + penicillin sodium for injection) + surgery (laparoscopic hepatic left outer lobe resection)
Treatment period】2 weeks of hospitalization and 1 month of postoperative review
Treatment effect] Discomfort under the fenestra disappeared and normal life and work resumed
I. Initial consultation
The patient presented to the emergency room for 6 hours with a sudden onset of subxiphoid pain, accompanied by nausea and vomiting. The patient’s medical history showed that he had been suffering from discomfort in the fossa of the heart for many years, and had been seen at a local clinic. Routine blood and liver function tests were done for the patient. Routine blood suggested slightly high blood levels and liver function suggested increased transaminases. Abdominal CT suggested intrahepatic bile duct stones in the left outer lobe of the liver. Based on the examination results and the patient’s symptoms, the patient was diagnosed with intrahepatic bile duct stones combined with infection, and was admitted to the hospital.
II. Treatment history
After admission, the patient was first given cefoperazone sodium for injection for anti-infection treatment and diammonium glycyrrhizate enteric solution capsule for hepatoprotective treatment. At the same time, intensive CT examination of the abdomen was completed, which revealed multiple stones in the bile ducts of the left outer lobe of the liver and inflammatory atrophy of the left outer lobe of the liver. The best treatment for this condition is to remove the diseased liver, which can eradicate the intrahepatic bile duct stones. After explaining the above condition to the patient and his family, the patient and his family agreed to the above treatment plan, and the patient underwent laparoscopic hepatic left outer lobe resection under general anesthesia 1 week later. After the operation, the patient continued to receive anti-infective penicillin sodium for injection and diammonium glycyrrhetinate enteric capsule for symptomatic support treatment.
III. Treatment effect
Because laparoscopic hepatic left lobectomy is a minimally invasive surgery with small incision and trauma, the patient recovered quickly and could get out of bed on the second postoperative day, and the pain of the incision was not obvious; on the third postoperative day, he could defecate and start to eat a liquid diet and gradually transition to a normal diet. During the recovery period, the patient’s symptoms of subxiphoid discomfort gradually disappeared, while no other complications occurred, and the incision healed well, and he was discharged on the 7th postoperative day after stitch removal. About 1 month after the operation, he resumed normal work life. The patient and her family were very satisfied with the results of this treatment.
IV. Notes
We are glad that the patient recovered after medication and surgical treatment. We suggest the patient to continue to pay attention to rest, avoid strenuous activities, avoid getting cold and continue to strengthen nutrition after discharge. Since the operation is a liver resection, the liver function is affected to a certain extent, so attention should be paid to follow the doctor’s instruction to review 1 month after the operation. The items of review include: liver function examination and abdominal CT examination. The liver function examination mainly checks the effect of the operation on the liver function; the abdominal CT examination mainly clarifies the healing of the surgical wound in the abdominal cavity and excludes the recurrence of fluid and stones in the abdominal cavity.
V. Personal insight
The early symptoms of intrahepatic bile duct stones are mostly abdominal discomfort, mainly in the subxiphoid or right upper abdomen, so many patients initially think it is a stomach disease and do not choose to go to a regular medical institution for examination. As in the case of the patient in this case, the symptoms have been repeated for many years and have been treated according to gastric disease. Therefore, for similar cases, if symptoms of discomfort in the subxiphoid or right upper abdomen appear, you should seek medical attention in a timely manner to clarify the diagnosis, detect it early and treat it symptomatically. Doctors also need to pay attention to identification to avoid causing confusion with intrahepatic bile duct stones, heart disease, and gastric disease to the point of delaying treatment and prolonging the course of the disease.