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A patient with acute calculous cholecystitis caused gallbladder
Author:xaszxyy  Release date:2018-09-03


    Recently, a 65-year-old female patient with gallstones, type 2 diabetes, and high blood pressure came to the Xi'an Central Hospital because of pain in the right upper quadrant and fever and diarrhea. Ultrasonography and abdominal CT showed that the patient had large gallbladder volume and calculous cholecystitis. After anti - inflammatory treatment, abdominal pain did not improve significantly and was transferred to general second department. After consultation, Xiaopeng Gao, director of digestive department Kun Zhuang, and deputy chief physician Xin Zhang, suggested laparoscopic surgery.
However, the development of disease was unexpected. On April 18, the ultrasound physician was surprised to find that the stone was stuck in the neck of the gallbladder, and the gallbladder increased significantly by 23x8.9cm, forming a huge cystic mass, which was the largest gallbladder in our hospital in recent years! The gallbladder was filled with thick bile and inflammatory exudate, which may result in gallbladder perforation at any time. The patient had a variety of chronic diseases, and the blood gas examination indicated type I respiratory failure (oxygen saturation 84%, arterial oxygen partial pressure 46mmHg), and the risk of anesthesia and surgery was greatly increased.

    The rapid progress of the disease and various complications caused the treatment to be in a dilemma. After repeated discussions and full communication with the family members, director Xiao an Ma, deputy director Xiaopeng Gao and director Yu Zheng of the department of ultrasound decided to conduct percutaneous transcutaneous gallbladder puncture and catheterization (PTGD) under the guidance of ultrasound first, and to select the surgery after drainage decompression. Because the patient's gallbladder was very large, the risk of sudden rupture during puncture was very high. After adequate preoperative preparation, PTGD was performed for the patient by Dr. Yu Zheng and Dr. Yuan Wu, under the close monitoring of the team of the department of general second. First, a small amount of bile is taken out with the finest puncture needle, and then the special gallbladder drainage tube is quickly placed. The entire surgical procedure required coordination, accurateness and rapidness. It must be success at one time. After the drainage tube was placed, 205 mL of dark brown thick liquid was withdrawn through the drainage tube, the volume of the gallbladder was significantly reduced, and the symptoms of the patient were obviously relieved. After careful treatment, the blood oxygen saturation and inflammatory indexes of the patient returned to normal.
Related knowledge link:
    PTGD is mainly used to treat critically ill and elderly patients with acute cholecystitis and high risk of surgery. It can also achieve biliary drainage for patients with low biliary obstruction. Besides, it can quickly reduce gallbladder pressure, immediately relieve symptoms and provide good chance for elective surgery. The Department of Ultrasound Diagnosis of our hospital has routinely carried out this technology, and has accumulated more than 100 cases each year, achieving ideal clinical results.