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Abstract: The patient presented to our hospital with paroxysmal abdominal cramps with nausea and vomiting, and was admitted with common bile duct stones as the main disease after confirming the patient’s condition through physical examination combined with the patient’s symptoms and abdominal CT examination. After admission, the patient and his family agreed. After determining that there were no contraindications to surgery, the patient was treated with common bile duct lithotomy and cholecystectomy, followed by postoperative anti-inflammatory and acid suppression treatment.
Basic information】Female, 82 years old
Type of disease】Choledocholithiasis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】January 2022
Treatment plan】Surgical treatment (choledochotomy + cholecystectomy) + intravenous injection (cefoperazone sodium sulbactam sodium, octreotide acetate injection, cimetidine injection)
[Treatment period] 1 week, review after 1 month
Treatment effect] The disease was cured and the common bile duct stones were removed
I. Initial consultation
The patient was 82 years old, and reported that she started to have paroxysmal abdominal cramps, mainly in the upper and middle abdomen, with no obvious pattern, accompanied by nausea and vomiting, the vomit was stomach contents, no coffee-colored material, non-jetting, with reduced anal discharge, occasional heartburn, no acid reflux, diarrhea, vomiting blood, black stool and other symptoms. He was treated with infusion at the local community service station (drug name and dosage unknown), but the effect was not good, so he came to our hospital for further diagnosis and treatment. On examination, I found that the patient had generalized mucosal yellowing of the skin, moderate yellowing of the sclera, slightly distended abdomen, no palpable mass in the whole abdomen, pressure pain in the middle and upper abdomen, no rebound pain, abdominal percussions and bowel sounds about 2 times/min. The patient was admitted to the hospital with common bile duct stones in combination with symptoms.
II. Treatment
After admission, I told the patient that he needed to undergo choledochotomy and cholecystectomy to remove the stones from the common bile duct and gallbladder because of the complications of cholecystitis and cholangitis, and he also needed intravenous cefoperazone sodium sulbactam, octreotide acetate injection and cimetidine injection for anti-inflammatory, pancreatic enzyme inhibiting and acid suppressing treatment after surgery. The patient and his family considered carefully and then decided to give the patient a new treatment. After careful consideration, the patient and his family agreed to this treatment plan. So I operated on the patient under general anesthesia after the patient completed the relevant examinations and determined that there were no contraindications to surgery, and the above drugs were administered intravenously after surgery. The patient was discharged after 1 week of hospitalization, and was instructed to review the patient in 1 month.
III. Treatment results
The patient had paroxysmal abdominal cramps with nausea and vomiting before treatment. After surgical removal of the common bile duct and gallbladder stones and anti-infection treatment, the patient’s above symptoms disappeared and he reported feeling well. One month later, the patient’s wound was found to be completely healed and no recurrence of common bile duct stones was detected by abdominal CT examination.
IV. Precautions
I was very happy that the patient was basically cured and discharged from the hospital. However, considering that the patient’s surgical wound was not completely healed, I still need to tell the patient to take more bed rest and reduce weight-bearing activities after going home, and to eat less oily and spicy food to avoid affecting the wound healing. Patients also need to be properly active, which can promote blood circulation and metabolism, which is beneficial to wound healing. In addition, patients need to pay attention to dietary hygiene to avoid biliary tract infections and reduce the chance of recurrence of common bile duct stones; pay attention to regular follow-up examinations to detect biliary tract abnormalities in a timely manner and provide targeted treatment.
V. Personal insight
Although the etiology of common bile duct stones is not clear, there are age, biliary tract infection, biliary ascariasis and other predisposing factors, among which people who do not pay attention to dietary hygiene or older people like the 82-year-old patient in this case are at high risk for this disease. Because of the severity of the symptoms and the complications of gallbladder stones, cholecystitis and other diseases, surgery combined with medication is required to cure the disease. Some patients may have mild symptoms, no complications, and have small common bile duct stones, which do not require surgery and can be expelled on their own by drinking more water. However, if symptoms such as significant abdominal pain occur, it is still necessary to seek prompt medical attention and, if necessary, surgery.