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Abstract: This patient had frequent episodes of right upper abdominal pain after eating for 3 months, and thought it was a gastric disease, then severe right upper abdominal pain occurred after eating fatty food, diffusing to the whole abdomen, accompanied by vomiting, so she came to the hospital. The patient’s abdominal pain improved and he could regain his basic appetite.
Basic information】Male, 65 years old
Disease Type】Gallbladder perforation with gallstones
Hospital】Liaocheng People’s Hospital
Consultation time】March 2022
Treatment plan】Medication (cefoperazone sodium sulbactam for injection + scopolamine hydrochloride injection + saline) + surgery (laparoscopic cholecystectomy) + abdominal pus and placement of drainage
Treatment period】Hospitalization for 5 days, outpatient follow-up after half a month
Treatment effect】abdominal pain disappeared, appetite restored
I. Initial consultation
We suddenly received a call from the emergency room at around 3:00 pm, saying that a patient with gallbladder perforation had arrived. We rushed to the emergency clinic and found the patient curled up in bed with a painful face. After questioning the patient’s medical history, it was found that the patient had frequent episodes of right upper abdominal pain after eating in the past 3 months, occasionally accompanied by nausea and vomiting, without fever. Today, after eating fatty food at noon, he had another episode of severe right upper abdominal pain, which diffused to the whole abdomen half an hour later, accompanied by vomiting once, with routine blood suggesting high WBC and CRP, and abdominal CT suggesting gallbladder stones and gallbladder perforation.
II. Treatment history
After admission, the patient was treated with cefoperazone sodium sulbactam sodium for injection, anti-infection and antispasmodic treatment with scopolamine hydrochloride injection, and saline rehydration to maintain electrolyte balance. The patient and family were then informed that although the abdominal pain was relieved, surgery should be performed immediately, otherwise it would be more dangerous, and the patient and family expressed their understanding and agreement. After the operation, the patient was discharged from the hospital after 5 days with the drainage tube removed.
III. Treatment effect
The patient’s abdominal pain symptoms improved significantly after drug treatment, and then under surgical treatment, the abdominal pain symptoms were effectively eliminated, the vomiting symptoms also disappeared, and the appetite increased. 5 days after the infusion and surgical treatment, the patient’s routine blood tests showed that the WBC and CRP indicators returned to normal levels, and the patient was discharged.
IV. Notes
Since the gallbladder is an organ for storing bile rather than producing bile, and bile has the function of digesting fat, the patient should be advised to eat less fatty food and mainly light and easy to digest food within six months after cholecystectomy, and to avoid eating spicy and stimulating food. Since the gallbladder duct will gradually expand and replace part of the gallbladder after gallbladder removal, the diet can gradually return to normal, do not be too hasty, overeating, must control the amount of food. In daily life, we should make it a habit to eat breakfast, and if the symptoms of right upper abdominal pain after eating appear, we should consult a doctor in time to avoid the development of the disease leading to gallbladder perforation, which brings great pain.
V. Personal insight
If right upper abdominal pain occurs frequently, especially after eating a lot of food and eating fatty food, consider the possibility of gallbladder perforation, and be sure to seek medical examination and treatment early to avoid causing other uncomfortable symptoms. Mild cases can be cured by infusion, but surgery is recommended for gallbladder perforation combined with gallbladder stones. It should be noted that gallbladder perforation can aggravate the disease if dragged for a long time, causing septicemia or even gangrene. Therefore, like the patient in this case, prompt medical attention for surgical removal of the gallbladder and adequate flushing of the abdominal cavity after the onset of discomfort from gallbladder perforation or gallbladder stones can avoid residual inflammation and effectively eliminate the symptoms of abdominal pain.