Gallbladder perforation
Acupuncture improperly documented injuries gall organs also first appeared in the “Yellow Emperor”, said: “thorn in the gall bladder, a day to death, and the dynamic of vomit” (“Su asked ban on gill”). Modern domestic first seen in 1959 [1], so far more than 10 cases have been publicly reported. There are statistics about accidental needle injury 1.3%. Despite the deeper parts of the gallbladder where the smaller size, the surface smooth and there is a certain tension, as well as in front of the liver and other organs of coverage protection. However, the above data indicate that both past and present, such incidents by no means rare, it is worth acupuncture practitioners vigilance.
Because acupuncture gallbladder injury after more than can cause acute abdomen, such as the treatment is not timely, easily lead to serious consequences, so try to avoid accidents, or when an accident occurs, the be disposed of as soon as possible, has a very important significance.
[Injury]
In general, the needle easily hurt gallbladder, where it is because the deeper parts of the gallbladder, smaller, and have a smooth surface tension and the front cover and other organs such as the liver. Gallbladder caused by stab wounds about the following several reasons:
An acupoint reasons: normal gallbladder, its shaped like a pear, about 7 ~ 9cm, width 2.5 ~ 3.5cm. Its surface projection of the general location of the outer edge of the right side of the rectus abdominis and ninth costal intersection. Gallbladder peritoneum package is not complete, only the ventral surface of the liver capsule and sides reflexed be covered, and its exposure to the bottom of the bag at the intersection.
Likely to result in injury gallbladder points: the right of the door, sun and moon, not, bearing full and Shangwan, dove tail and so on.
Second, the pathological reasons: biliary obstruction or gallbladder itself, the existence of the disease (such as stones, inflammation, foreign bodies, tumors, etc.), can cause gallbladder bile filling, not only can it increase in size, and often make the gallbladder rough surface, the lack of appropriate elasticity and tension susceptible to breakage acupuncture wall. Meanwhile, the enlargement of the gallbladder, the intraluminal pressure increased significantly, once punctured, you can promote bile outflow perforation easily closed, thereby increasing spread and promote inflammation.
Secondly, enlargement of the liver can gallbladder down position, gallbladder disease itself enlargement, changes in position will cause the surface projection system so that the points increase, if any, reported acupuncture Liangmen point lead throughout the body gallbladder perforation.
Third, the reason for the action: Acupuncture too deep, especially for patients with gallbladder enlargement, it is one of the important reasons causing the accident. Practices are not familiar with the lift and thrust repeatedly pound move, not only can stab the gallbladder, but also led to many wall perforation. Selected needle is too thick too long, will increase the chance of gallbladder perforation. Acupuncture in the wrong direction, but also one of the reasons, often in non-cystic projection area acupuncture, acupuncture direction due to incorrect punctured gallbladder.
Clinical manifestations
Acupuncture injure the gallbladder, gallbladder perforation in common. Its site of injury, common in the bottom of the gallbladder, gallbladder also pierce the body; may be through injury, also may only hurt the side wall. Outflow of bile peritonitis caused by varying degrees of symptoms. According to the patient’s body, whether gallbladder disease, perforation size, bile outflow extent, sub-clinical inflammation around the gallbladder, localized peritonitis and diffuse peritonitis several species, extent, severity of difference.
One, mild: may have abdominal pain and tenderness, can be accompanied by nausea and vomiting. Some within the 24 ~ 26h symptoms do not appear, it is necessary to observe.
Second, severe: more than acupuncture symptoms. Manifested as severe right upper quadrant pain was persistent and gradually spread to the whole abdomen, with significant tenderness (in Youlei most obvious), rebound tenderness and muscle tension. Nausea, vomiting, general can be presented fever, rapid pulse, rapid shallow breathing and other symptoms of poisoning. Especially due to bile spilled into the abdominal cavity, strongly stimulated peritoneal exudate plenty of fluids, reduce circulating blood volume, easily appear low blood shock. Abdominal puncture, multi-extractable yellow bile, help diagnose: white blood cell count rose to more than 1500/mm3, neutrophils.
[Prevention]
First, carefully selected points: whether the needle should know before gallbladder and liver disease history, check the right upper quadrant, as palpable enlargement of the gallbladder, preferably not in this range acupoints. Such as enlargement of the liver, but also should be aware of the specific location of the gallbladder. Whenever such a situation, the lack of experience are concerned, all the way acupoints or left to the right to take appropriate disease.
Second, pay attention to: local points, even in the case of normal liver and gallbladder should be light superficial stab stab, do not pierce the peritoneum. On the door, sun and moon and other points, clinically difficult to get gas. Our experience is that the tip can be a little biased rib edge obliquely to reach the bone surface, mention plug Twist, often appear satisfied with acupuncture, but avoid substantial disorder trouble plug. If the gallbladder enlargement, access to local points, should elect 30 needles, needle retention time not too long (usually 10 ~ 15min), and the patient is asked to maintain the original position, do not arbitrarily change. Take the needle, you can make it in the clinic rest 30min, in order to observe any adverse reactions.
[Processing Method]
According to acupuncture, clinical syndromes, systemic inflammatory state the scope and take a different treatment.
One, mild: general condition is good, original without cystic lesions, can be taken to conservative treatment, surgery lying rest, and apply Lee gas pain relief, detoxification anti-inflammatory pain medicine or western medicine, when necessary, fasting and decompression , and the body fluid treatment, add enough water, sugar, electrolytes and vitamins.
Second, severe: poor general condition, severe symptoms of systemic poisoning, or non-surgical therapy did not improve, surgery should seize the opportunity to turn an operation. Light as a suture, serious shall make cholecystectomy.