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CPR, surgery save patient with ruptured gall bladder

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Dr. Imran Shaikh

 Rohit Shishodia
Ignoring prolonged gall bladder stone proved costly for a 56-year-old man from Thane as he suffered from rupture in the bladder which caused infection and multi organ failure.

The patient, however, was saved by doctors at Mumbai’s Wockhardt Hospital after first performing CPR to revive him and then conducting a complex surgery. The patient has been discharged and has resumed his work.

The treating doctors have advised patients who have gall bladder stone to undergo surgery as early as possible to avert any complication like rupture in the gallbladder which can even kill the patient.

They said that a lot of people take gallbladder stone very lightly, but it has associated complications like acute infection, jaundice, perforation, gangrene, and cancer. Such complications can be averted by simple laparoscopic surgery in elective settings which requires only a one-day hospital stay.

The patient, Mr. Prakash Acharya, of Bhayandar, was very critical. With lifesaving support for heart and lung, he underwent major life-saving surgery - exploratory laparotomy with cholecystectomy and peritoneal lavage with drainage.

The patient encountered excruciating abdominal pain and vomiting. The pain was so severe that he needed injections and couldn’t eat food.

He was admitted to a nearby nursing home and on evaluation was found to have gall bladder stone with severe infection and complications 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 planned gall bladder surgery at a nursing home.

After anesthesia, he suffered from cardiac arrest and was given CPR to revive him.

After two attempts at CPR, he was revived and surgery was deferred. He was put on a ventilator and shifted for further management at the Wockhardt.

Dr. Imran Shaikh, Consultant GI and HPB Surgeon, Wockhardt Hospital, said, “The patient was unstable with 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%.”

Dr Shaikh further said that the patient 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.

CT scan showed worsening infection in the abdomen as well as in chest. The patient's vigorous resuscitation continued. Higher antibiotics, nutritional support, ventilatory and BP support, and kidney support were continued.

The most important decision was to operate upon him which was supra major surgery. 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 a little better to subject him to surgery. Surgery lasted for four hours,” said Dr Shaikh.

During surgery, lot of pus and infection was drained from the abdomen and the gall bladder was removed. The whole abdomen was thoroughly cleaned. He was shifted to ICU on all life saving support.

As soon surgery controlled the source of infection, he showed remarkable recovery in ICU. Within 72 hours his heart and BP stabilized and kidneys improved.

Though he required a ventilator for five days, he made an uneventful recovery. After 7 days of surgery, he was shifted to full diet. While recovering he was drowsy. Even as all organs were improving, neurologist's opinion was sought.

The biggest fear was hypoxic brain injury which happens due to a lack of blood supply to the brain when the heart was stopped twice. But fortunately, no major injury to the brain was detected.


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