65-Year-Old Man Experiences Stomach Pain After Meals—Turns Out to Be Gallbladder Perforation

Summary: A 65-year-old male experienced recurring right upper quadrant pain for three months, initially mistaking it for a stomach issue. After consuming fatty foods, he suffered severe abdominal pain that spread throughout his abdomen, accompanied by vomiting. He was diagnosed with gallbladder perforation and gallstones at the hospital. Following antibiotic treatment and laparoscopic cholecystectomy, his symptoms improved significantly, and his appetite gradually returned.

Patient Profile: Male, 65 years old
Diagnosis: Gallbladder perforation with gallstones
Hospital: People's Hospital of Liaocheng City
Visit Date: March 2022
Treatment: Intravenous antibiotics (Cefoperazone Sodium and Sulbactam Sodium), antispasmodic medication (Racemic Scopolamine), laparoscopic cholecystectomy, and abdominal drainage
Recovery Time: 5-day hospital stay with a follow-up visit scheduled two weeks later
Outcome: Abdominal pain resolved and appetite improved

1. Initial Consultation: Around 3 p.m., an emergency call came in about a patient suspected of gallbladder rupture. Upon arrival, the patient was curled up in bed, clearly in pain. He had been experiencing recurring right upper abdominal pain after eating for the past three months. He occasionally felt nauseous and vomited but had no fever. He assumed it was a stomach problem and took over-the-counter digestive tablets at home. After eating fatty food at lunch, he developed severe pain in the upper right abdomen, which quickly spread throughout the abdomen, along with one episode of vomiting. Blood tests showed elevated white blood cell count (WBC) and C-reactive protein (CRP). Abdominal CT confirmed gallstones and gallbladder perforation.

2. Treatment Process: Upon admission, he was given intravenous antibiotics and antispasmodics to manage infection and pain. Fluid therapy was administered to maintain electrolyte balance. His abdominal pain improved after the IV treatment. The medical team explained the need for immediate surgery to prevent life-threatening complications. The patient and his family agreed, and he underwent laparoscopic cholecystectomy. During surgery, the abdominal cavity was thoroughly rinsed, and a drainage tube was placed. Postoperatively, antibiotics and antispasmodics were continued, and the drainage tube was kept open. After five days, the tube was removed, and the patient was discharged.

3. Treatment Results: After medical treatment and surgery, the patient's abdominal pain and vomiting ceased. His appetite gradually returned. Blood tests taken before discharge showed WBC and CRP levels had normalized. He was advised to return for a follow-up appointment in two weeks.

4. Key Recommendations: It's fortunate the patient sought treatment early. Since the gallbladder stores bile—which helps digest fats—patients are advised to eat low-fat, easily digestible meals for the first six months after surgery. Spicy and irritating foods should also be avoided. Over time, the bile duct may expand slightly to compensate for the missing gallbladder, so patients should gradually reintroduce regular foods into their diet. Eating breakfast regularly and avoiding overeating are crucial. If right upper abdominal pain occurs after meals, prompt medical attention is necessary to prevent complications like gallbladder perforation.

5. Clinical Insight: Persistent right upper abdominal pain, especially after heavy or fatty meals, could indicate gallbladder issues. Early diagnosis and treatment are essential. While mild cases can be managed with medication, gallbladder perforation with gallstones typically requires surgery. Delaying treatment can lead to severe complications such as abscess formation or gangrene. As in this case, timely surgical removal of the gallbladder and thorough abdominal irrigation can effectively eliminate pain and prevent long-term inflammation.