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Gallstone infections are not uncommon. The clinical presentation most of the time is very specific. Most commonly there is dull aching discomfort in the upper abdomen, occasional nausea, and sometimes vomiting. Progressively patients will develop pain on the right side of the abdomen and sometimes fever which brings them to the emergency room. Occasionally patients persist to have low-grade pain and fever giving false reassurance.
Primary infection with gallstones is very common. However mild infection is still not uncommon and more than half the patients have mild pain during the initial stages of biliary colic. Here our patient was seen and evaluated by MH Surgery Clinic surgeons for specific symptoms that were related to gallbladder infection.
During the evaluation, she was found to have symptoms of multiple gallstone attacks. She was evaluated and further investigations were performed. She was also noted to have a mild elevation in her blood infection markers. She was managed by our surgeons at Surgical Gastroenterology Center in MH Surgery Clinic. She underwent a high-resolution computed tomography scan of the abdomen which confirmed our suspicion of gallstone infection. She was immediately offered surgery. She was counseled regarding the importance of surgery and the timing of surgery on an urgent need basis.
Though she seemed to be convinced her priorities were different and she wanted to wait. She was advised to undergo immediate surgery. However, she seemed very determined and was unmoved by our discussion. Nearly a month later, after she had completed her obligation she came into the hospital as an emergency with severe pain and chills. She was re-evaluated to rule out any further complications during the waiting period. She was offered surgery and was taken to the operating room.
During the surgery, there were adhesions of the gallbladder to the surrounding structures and liver. There was murky fluid that was accumulating in her abdomen. The gallbladder was distended and probably with micro-perforations. A simple one-hour surgery turned into a complicated surgery requiring time and tremendous effort from a surgical technique perspective. The gallbladder was removed and the surgery was successfully completed using minimally invasive surgery. All this was performed via a Minimally Invasive Advanced Surgery technique. The patient recovered extremely well and remained insignificant low pain and was discharged home in two days.
In many patients, this diagnosis is clearly identified or explained in detail to the patient. Some patients refuse the need for surgery and this further leads to a complicated situation. some patients can also require further surgeries because of a complicated disease. She was clearly lucky to have not progressed to a full-blown infection but some patients may not be so lucky. As with all surgical diseases, the sooner surgery is performed the outcome is better. All cases need careful evaluation and management. Such patients require careful evaluation and surgical correction which is available at Surgical Gastroenterology Center in MH Surgery Clinic.