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糖尿病合并胆囊重复畸形并发急性胆囊炎患者的外科治疗:病例报告

The surgical management of a diabetic patient with gallbladder duplication complicated by acute cholecystitis: Case report.

作者信息

Alqahtani Abdulaziz, Alshehri Abdulaziz, Hazazi Ibrahim, Alkhaldi Abdullah, Alyami Hassan

机构信息

Department of General Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.

Department of General Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2024 Dec;125:110577. doi: 10.1016/j.ijscr.2024.110577. Epub 2024 Nov 16.

Abstract

BACKGROUND

Duplication of the gallbladder is a rare occurrence and seldom detected before surgery but can complicate the procedure, potentially leading to a higher likelihood of converting to open surgery and encountering complications. Symptoms, when present, typically relate to gallstone disease and cholecystitis. We report a unique case of a diabetic patient with duplicate gallbladder complicated by acute cholecystitis, which was effectively treated through laparoscopic cholecystectomy.

PRESENTATION OF CASE

A 51-year-old man with well-managed diabetes presented with right upper quadrant pain worsened by fatty meals. Initially diagnosed with acute acalculous cholecystitis, he was treated conservatively with antibiotics and pain relief. Recurrent symptoms led to cholecystostomy tube insertion, offering temporary relief. Subsequent imaging identified a double gallbladder with inflammatory changes, confirmed by magnetic resonance cholangiopancreatography. Elective laparoscopic cholecystectomy was performed, revealing an inflamed double gallbladder with a unique arterial supply. Histopathology showed inflammation without malignancy, and the procedure was complication-free.

DISCUSSION

Reporting this case of gallbladder duplication in a diabetic patient suffering from acute cholecystitis is important due to its rarity and surgical management challenges it presents. This case offers valuable insights into handling complex biliary anatomies, highlights the necessity for customized surgical techniques and thorough perioperative care, and enriches the medical literature by adding knowledge about uncommon surgical situations.

CONCLUSION

The case presented highlights the successful surgical management of acute cholecystitis in a diabetic patient with gallbladder duplication. Despite the anatomical complexity, laparoscopic techniques proved effective in achieving successful surgical outcomes with minimal invasiveness and reduced postoperative complications.

摘要

背景

胆囊重复是一种罕见情况,术前很少被发现,但会使手术复杂化,可能导致更高的转为开腹手术的可能性并出现并发症。出现症状时,通常与胆结石病和胆囊炎有关。我们报告一例独特的病例,一名糖尿病患者合并重复胆囊并伴有急性胆囊炎,通过腹腔镜胆囊切除术得到有效治疗。

病例介绍

一名51岁男性,糖尿病病情控制良好,因进食油腻食物后右上腹疼痛加重前来就诊。最初诊断为急性非结石性胆囊炎,给予抗生素和止痛药物进行保守治疗。反复出现的症状导致插入胆囊造瘘管,暂时缓解了症状。随后的影像学检查发现一个有炎症改变的双胆囊,磁共振胰胆管造影证实了这一情况。进行了择期腹腔镜胆囊切除术,发现一个发炎的双胆囊,其动脉供应独特。组织病理学显示为炎症,无恶性病变,手术无并发症。

讨论

报告这例患有急性胆囊炎的糖尿病患者的胆囊重复病例很重要,因为其罕见性以及所带来的手术管理挑战。该病例为处理复杂的胆道解剖结构提供了有价值的见解,强调了定制手术技术和全面围手术期护理的必要性,并通过增加关于罕见手术情况的知识丰富了医学文献。

结论

所呈现的病例突出了对患有胆囊重复的糖尿病患者急性胆囊炎的成功手术管理。尽管解剖结构复杂,但腹腔镜技术被证明在以最小的侵入性实现成功手术结果并减少术后并发症方面是有效的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9d3/11617922/af5f977e5e47/gr1.jpg

相似文献

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Acute Cholecystitis: A Review.急性胆囊炎:综述。
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本文引用的文献

7
Laparoscopic treatment of duplicate gallbladder with acute cholecystitis.腹腔镜治疗重复胆囊伴急性胆囊炎
J Minim Access Surg. 2020 Oct-Dec;16(4):447-448. doi: 10.4103/jmas.JMAS_231_19.
10
Laparoscopic double cholecystectomy for duplicated gallbladder: A case report.腹腔镜下重复胆囊双胆囊切除术:一例报告
Int J Surg Case Rep. 2017 Nov 27;41:502-504. doi: 10.1016/j.ijscr.2017.11.046. eCollection 2017.

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