A team headed by Dr Imran Shaikh, Consultant GI & HPB surgeon, Wockhardt Hospital, Mira Road, saved the life of a 56-year-old man with an infection and ruptured gall bladder that led to multiorgan failure. The patient was very critical with lifesaving supports for heart and lung, underwent major life-saving surgery – Exploratory laparotomy with cholecystectomy and peritoneal lavage with drainage. The patient is discharged after 15 days and he is now resumed back his work.

Mr Prakash Acharya, a 56-year-old resident Bhayandar, who is working as supervisor encountered severe excruciating abdominal pain and Vomiting. He experienced this kind of pain the first time. The pain was so severe that he needed injections and also, he couldn’t eat food. Though, he didn’t have other comorbidities such as diabetes and hypertension. He was admitted to a nearby nursing home and on evaluation found to have Gall bladder stone with severe infection and complication like rupture of Gall bladder. There was a severe infection along with multiorgan failure that took a toll on his kidneys, lungs, and heart. He was critical and planed Gall bladder surgery at a nursing home.

To the patient’s dismay, after anaesthesia, he suffered from cardiac arrest and was given Cardiopulmonary resuscitation (CPR), a life-saving technique to revive him. After two attempts of CPR, he was revived and surgery was deferred. He was put on a ventilator and shifted for further management at Wockhardt Hospital, Mira Road.

Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospital, Mira Road highlighted, “Patient arrived in very bad shape. In the emergency room, the patient was unstable with on high ventilatory and cardiac support. The patient was shifted to ICU on life-saving support. The condition was so critical that despite maximum ventilatory support his oxygen saturation would remain around 88 %. He required three lifesaving drugs in very high dosages to barely maintain his heart and Blood pressure. His kidney was hit badly with high creatinine and low urine output. Emergency CT scan of chest and abdomen done which showed worsening infection in the abdomen as well as in chest. Patients vigorous resuscitation continued in ICU as per standard protocol. Higher antibiotics, nutritional support, ventilatory and BP support and Kidney supports were continued.

A most important decision was to operate upon him which was supra major surgery and considering the critical status of the patient it would have been a very high risk to his life. We waited almost 24 hours and continued resuscitation before we could make him little better to subject for surgery. Team of doctors including Intensivist, Physician, Chest Physician, Cardiologist and Gastrosurgery tried very hard to make him stable so that surgery can be performed. Surgery was lasted for four hours & Patient tolerated surgery very well. During surgery lot of pus and infection drained from the abdomen and Gall bladder was removed. The whole abdomen was thoroughly cleaned.

He was shifted to ICU on all lifesaving support. As soon surgery controlled the source of infection, he showed remarkable recovery in ICU. Within 72 hours his heart and BP stabilised and kidneys improved. Though he required a ventilator for 5 days but made an uneventful recovery. After 7 days of surgery, he was shifted towards on full diet. While recovering in the remains drowsy Inspite all other organs were improving, so neurologist opinion was sought. Biggest fear was hypoxic brain injury which happens due to lack of blood supply to the brain when the heart was stopped twice. But fortunately, no major injury to brain detected and he improved on medical management. After two weeks from surgery, he was all fit and discharged.

A lot of people take Gall bladder stone very lightly, but it has associated with a complication like acute infection, Jaundice, perforation, gangrene and Cancer. All these complications are life-threatening. We can avoid this complication by simple Laparoscopic surgery in an elective setting which requires an only one-day hospital stay. Also, whenever complication happens it should be managed at the tertiary care centre where all facilities and experts are available. We could save this patients life purely because of teamwork and facilities.

“My abdominal pain was unbearable to the extent that I couldn’t even move or walk properly. My world came crashing down after I got to know that the gallbladder has ruptured. I was hoping for some miracle to happen and was happy to know that the doctors gave me a fresh lease of life. I thank the doctors for their limitless efforts taken amid the pandemic. Now, I can do my daily chores with ease and have resumed to normal life,” concluded patient Mr Prakash Acharya.

Source: http://mediabulletins.com/health/gall-bladder-infection-with-rupture-induced-multiorgan-failure-and-cardiac-arrest-in-56-year-old-man-successfully-operated-at-wockhardt-hospital-mira-road/