Ms. NTH (62 years old, Ho Chi Minh City) was admitted to the emergency room due to abdominal pain, fever, chills and tremors. A year before that, she had been treated for necrotizing pancreatitis for about two months at a hospital but was not scheduled to have her gallbladder removed afterward.
Ms. H. was not treated completely when she had necrotizing pancreatitis due to previous gallbladder stones, leading to complications of gallbladder stones falling into the common bile duct, blocking the bile duct. Chronic inflammation of the gallbladder due to stones and pancreatitis at the same time makes it difficult for doctors to identify the structure, causing a high risk of complications during surgery such as bleeding and damage to the biliary tract.
After surgery, Mrs. H. had no abdominal pain. After 10 days of follow-up examination, the common bile duct was clean of stones and his health recovered well.
According to Dr. Pham Cong Khanh - Head of the Department of Hepatology - Biliary - Pancreas, Center for Endoscopy and Gastrointestinal Surgery, Tam General Hospital in Ho Chi Minh City, in the first 6 months of the year, the hospital received nearly 800 people with gallstones. gallstones, in which the rate of complications due to gallstones is three times higher than the same period last year. 38% of these had complications of acute cholecystitis.
The rate of acute cholecystitis increases because patients are at risk of acute cholecystitis but refuse surgery to take stone-dissolving drugs, fearing that gallbladder removal will affect their health. Some people with many diseases such as cardiovascular, respiratory, diabetes, taking antiplatelet drugs, anticoagulants... cannot have surgery. "Patients who are not examined by a doctor before and advise them to have early surgery can cause complications if the disease lasts a long time," said Dr. Khanh.
Gallbladder stones are quite common and tend to progress silently and are difficult to detect early. Patients often get examined late, and in many cases, even though stones are detected, they are not treated completely, leading to acute cholecystitis, cholangitis, septic shock, acute pancreatitis, necrotizing pancreatitis...
Usually, these cases undergo endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in the common bile duct, and at the same time endoscopic cholecystectomy. However, in the case of Ms. NTH, due to the necrotic mass in the head of the pancreas, narrowing and deforming the duodenum, the common bile duct stone could not be accessed through endoscopic cholangiopancreatography. She had laparoscopic surgery to remove the gallbladder and at the same time dissect the common bile duct to remove two stones in the common bile duct.
Early stage stones are often treated with medication. When stones show symptoms, gallbladder surgery is needed. The most common treatment is laparoscopic cholecystectomy. Prescribing cholecystectomy is an art so that patients do not have their gallbladder removed unreasonably due to diseases with similar symptoms, nor do they keep taking ineffective stone-dissolving drugs until the disease becomes severe.
Gallbladder stones are easily detected through abdominal ultrasound with high accuracy. Patients need to proactively have regular health check-ups. People with symptoms of cholecystitis such as right upper quadrant pain, high fever, chills... should see a doctor immediately.
