Acute cholecystitis is the result of sudden inflammation of the gall bladder which causes marked abdominal pain, often associated with nausea, vomiting and fever. It usually develops due to the presence of gallstones, which are rock like deposits that are formed inside the gallbladder.
The gallstones can get blocked in bile ducts and obstruct the flow of bile from the gallbladder. This can cause episodes of abdominal pain/cramps called biliary colic. Besides pain, nausea, vomiting and fever it can also give rise to jaundice due to obstruction of the bile juice from the gallbladder.
Presented here is a case of a 52 year old engineer, diagnosed with acute cholecystitis, who could not undergo surgery when he presented with acute emergency, due to lockdown following the Covid 19 pandemic.
The patient presented with sudden onset of severe abdominal pains on 12/4/2020. He described the pain in his right hypochondrium as pressing and felt simultaneous pain in the scapular region of his back.
He had aggravation of pain right after the meals and was beginning to get nausea from the thought of food. He had vomited sour yellow curdled fluid twice. There was lot of anxiety due to the pandemic and with this pain he got all the more panicky.
He also had hypertension and suffered from sciatica pains on and off. He is of medium build, fair complexioned and a vegetarian. He craves milk, sweets and chocolates. He enjoys warm food rather than cold. He drinks 8 – 10 glasses of water daily. Bowels and bladder functions are normal. Sleep is good and he can sleep for long hours without getting disturbed by any noise or clatter.
Being a civil engineer, his life was pretty hectic. He had long working hours with practically no holidays. His routine was erratic; he did not have any fixed time for meals and sleep. He described his family as a scene from any daily soap opera, where people are constantly pouncing on each other. There is no peace and he chose to remain away from home to avoid getting into it.
He mentioned that on days he would be home, he too would become part of the drama and get irritated and nasty. His parents are very domineering and the fights are usually between his wife and his parents.
With the lockdown, his work had stopped and he was at home for a couple of weeks. It was a trying time for him as he had decided to control his anger. He had made up his mind to bring about change in himself.
He said that he had realised the importance of having good health and felt that he was neglecting his health all his life. He felt that his illness was because he had ignored his health.
When his complaints were at peak, he felt remorseful, realising that his suffering was a kind of punishment. It was the price he was paying for being guilty of having ruined his health and peace of mind.
His MRI showed that his gall bladder was over distended with few diverticuli, with few calculi, the largest being 9 x 7 mm. There was sludge and calculus in the distal common bile duct and mild hepatomegaly. Blood reports were all within normal range except raised levels of lipoprotein,
Lipoprotein – 37.3 mg/dl
Lipase – 58.4 mg/dl
Bilirubin (Total) – 2.67
SGOT – 90 U/I
SGPT – 168 U/I
He was advised immediate surgery, but due to lockdown could not get any appointment for surgery. He had lot of anxiety about his disease.
The characteristics in the case were:
Delusion, health, he has ruined – only remedy in Synthetic Repertory is Chelidonium
Anxiety, conscience, as if guilty of a crime – Synthetic Repertory Chelidonium 4 marks
Anxiety; conscience of, unpardonable sin, –
Irritable, bad tempered, tired of life
Abdomen, pain going backwards
Craving for Milk, warm food.
Nausea and vomiting from smell of food
Appetite – lost
Based on totality, I prescribed Chelidonium 200 tds on 17/4/2020. He was able to cut down on the pain killers within a week. On follow up after 10 days, his appetite had improved. Pain frequency and intensity was much better.
Chelidonium 200 was continued for another fortnight.
In the meantime, he returned to work. This time he had decided to be careful about his routine. Four months passed since his first episode of pain. He did not get any attack of pain or nausea for 4 months. He continued to take Chelidonium as a preventive medicine.
The patient had another acute episode on 2/09/2020: He had an acute episode of abdominal pain and was admitted to the hospital. He had severe epigastric pain, nausea and 3 episodes of vomiting. On examination he had a soft tenderness in the epigastric region.
USG abdomen on 12/09/2020 showed the gall bladder distended and with a calculus at the neck of the gall bladder. He was to undergo surgery, but because of Covid 19, they had to wait until his Covid test was done.
13/09/2020: MRCP was done. The finding was suggestive of acute calculus cholecystitis with sludge and calculi in the gall bladder with a calculus in the distal bile duct. The patient was kept on supportive care and preparations for surgery were being done. However, the patient spoke of resolving of his symptoms after which a repeat MRCP was done on 14/09/2020
On doing an MRCP there was signs of acute gall stone pancreatitis, the gall bladder was found to be minimally distended and very minimal sludge was seen. There was no sign of gall stone! The patient was stabilised and the pain reduced.
He was kept for observation and on supportive care. His serum lipase levels had risen. Chelidonium 200 was continued and he continued to improve speedily. He was discharged on the 19/09/2020 without having undergone surgery.
Investigations 12/09/2020: USG ABD
Investigations 13/09/2020: MRCP
Kent writes in his lectures: “This remedy has cured gall stone colic. Practitioners who know how to direct a remedy, can relieve gall stone colic in a few minutes. We have remedies that act on the circular fibers of these little tubes, causing them to relax and allowing the stone to pass painlessly.
In a perfect state of health, of course, there are no stones in the bile that is held in the gall bladder, but this little cystic duct opens its mouth and a little gall stone engages in it, and it creates an irritation by scratching along the mucous membrane of that little tube.
When this pain is a shooting, stabbing, tearing, lancinating pain, extending through to the back, Chelidonium will cure it. The instant it relieves, the patient says: “Why, what a relief; that pain has gone.” The remedy has relieved that spasm, the little duct opens up and the stone passes out through the ductus communis choledochus.”