Missed diagnosis of gallbladder fistula in 1 case of preoperative.docVIP

 PAGE \* MERGEFORMAT 5 Missed diagnosis of gallbladder fistula in 1 case of preoperative [Keywords:] before the missed diagnosis of gallbladder fistula surgery Gallbladder fistula is a rare complication of biliary tract disease, because no specific clinical symptoms, preoperative diagnosis difficult. Our hospital diagnosed and cured by surgery and 1 case of gallbladder fistula patients, are as follows. 1 Clinical data Male patient, 58 years old, mainly due to repeated episodes of upper abdominal pain admitted to hospital more than 6 years. The patients were abdominal pain was intermittent, paroxysmal increase, accompanied by the right shoulder back and radiating pain, abdominal pain, no regularity, no significant relationship with the consumption of , no fever, jaundice history, accompanied by nausea, acid reflux, tired of greasy food, no belching. examination: no abnormal heart and lung, abdomen soft, middle of upper abdominal tenderness, no rebound tenderness, Murphy negative sign to this hospital gallstone admission, underwent three conventional and blood biochemical tests, chest X films were no obvious abnormalities, ECG sinus rhythm, QRS axis deviation moderate left and right atrial hypertrophy, T wave flat, abdominal ultrasound Tip: gallbladder atrophy, gall bladder stones (full model), chronic cholecystitis. preoperative diagnosis: chronic cholecystitis with cholelithiasis, coronary heart disease. under general anesthesia during laparoscopic cholecystectomy, intraoperative see the antrum, and duodenal encapsulated form dense adhesions of gallbladder and liver, hilar, cystic triangle adhesions, laparoscopic cholecystectomy can not see under the microscope around the isolated gallbladder adhesions, revealed at the end of gallbladder, body, see gallbladder contraction, were white, twelve duodenum and gallbladder ampulla bulb was dense scar-like adhesions, laparoscopy can not be separated, then converted to open surgery. laparotomy adhesions se