A 75‑year‑old woman with a 35‑year history of Parkinson’s disease suffered a sudden duodenal perforation complicated by a liver abscess. As families gathered to celebrate the Spring Festival, this elderly patient hung on the brink of death, which was an extreme test of modern medicine and a hospital’s comprehensive capabilities.

On the occasion of 30th World Parkinson’s Day, we document this case from earlier this year. At Jiahui International Hospital, a dream team comprising Neurology, General Surgery, Gastroenterology, Intensive Care Unit (ICU), Adult Inpatient Unit, Medical Imaging, Anesthesiology, Nutrition, and Rehabilitation delivered multidisciplinary treatment (MDT) that exceeded expectations. They cleared a path to survival for Mrs. Zhang (pseudonym), redefining the depth and warmth of full‑cycle health management.

The Hidden Crisis: Beyond Just Parkinson’s Disease

Mrs. Zhang, who has lived with Parkinson’s disease for 35 years, suddenly developed severe symptoms like confusion and leg swelling in January 2026; doctors ruled out common illnesses but found dangerous inflammation, low protein, and abnormal air in her liver, so they ordered an urgent abdominal CT scan.

35 years is considered a very long duration for the condition. In 2021, Mrs. Zhang was admitted under the care of Dr. CHEN Yan, Chief Physician of Neurology at JIH, for persistent involuntary abnormal movements (dyskinesia). Over the six years, she remained mentally clear, polite and articulate, and able to walk independently.

One Sunday in mid‑January 2026, Dr. CHEN learned that Mrs. Zhang had developed intermittent cough, poor appetite, episodic confusion and psychiatric symptoms after receiving antibiotics at another hospital, along with worsening bilateral lower‑extremity edema (swelling in both legs). Drawing on her extensive clinical experience, Dr. CHEN immediately recognized this was not merely a Parkinson’s disease flare‑up. After detailed discussion with the family, she arranged for immediate admission to identify the underlying cause.

Upon admission to the Adult Inpatient Unit, the team led by Chief Physician Dr. Walter FANG rapidly launched an investigation. Given Mrs. Zhang’s multiple comorbidities, the team first ruled out common causes including deep vein thrombosis (blood clots in the leg veins), heart failure, thyroid and hepatorenal dysfunction (impaired liver and kidney function), and vitamin B1 deficiency syndrome. Yet her inflammatory markers continued to rise, albumin (a key protein maintaining fluid balance) plummeted (normal just 10 days prior), and she developed intermittent disorientation (confusion about time, place, or surroundings).

Against a background of severe malnutrition, reduced oral intake over one month, recent influenza A infection, and daily diarrhea, a chest CT incidentally revealed intrahepatic gas (abnormal air trapped within the liver tissue), and the team noted abnormal abdominal distension. Beyond routine tests, an urgent radiology consultation was requested, and an abdominal CT was arranged the same evening.

Dr. Elva DAI from Radiology, said, “Parkinson’s disease patients often experience sudden, uncontrollable severe tremors due to anxiety, which severely degrade imaging quality and blur scans. We allowed ample time for Mrs. Zhang to reduce anxiety. Our experienced technologists selected optimal sequences and parameters, and with ultra‑fast imaging from our advanced equipment, we precisely captured high‑definition lesions within brief intervals between tremors.

Backed by cutting‑edge technology and unhurried, compassionate care that transcends disease barriers, we stand firm in uncovering the truth for our patients.”

The results were shocking: An ulcer in the back of her duodenum (the first part of the small intestine) broke through and infected a nearby cyst in the liver, creating a pus-filled abscess. Several liver cysts pressed against her stomach and connected with the ulcer through an abnormal passage, letting multiple gut bacteria spread and cause severe infection.

Key Diagnostic Findings

• Hepatic cysts first identified in 2021 now showed air‑fluid levels in 2026, suggesting an internal fistula between the cyst and digestive tract causing infection.
• Careful review and coronal reconstruction revealed the relationship between the duodenal ulcer and intrahepatic lesions, with a suspicious fistula.
• Further abdominal MRI with MRCP sequences confirmed the presence of a tiny fistula, guiding subsequent treatment.

Dr. LI Jun of General Surgery, said, “Posterior duodenal bulb perforation typically causes acute peritonitis and is life‑threatening. Fortunately, the perforation extended into a hepatic cyst, resulting in milder initial symptoms. However, prolonged infection and poor oral intake left Mrs. Zhang in her current critical state.”

The Inpatient team immediately called for urgent joint consultations with Gastroenterology and General Surgery. After evaluation, Dr. LI recommended ultrasound‑guided abscess drainage combined with gastroscopy to control infection, locate the perforation, and prepare for potential surgery.

Yet for an elderly patient with a decades‑long Parkinson’s disease course and multiple comorbidities, emergency surgery carried extreme risks:

• Severe malnutrition made her intolerant to surgical trauma.
• Anesthetic agents could disrupt delicate neurochemical balance.
• Dramatic fluctuations in brain neurotransmitters raised the risk of neuroleptic malignant syndrome, a life‑threatening complication.

The family and medical team faced their first agonizing choice: to operate, or not to operate?

Choice Before Spring Festival: MDT Assembled for a Stepwise Strategy

Without surgery, infection would spiral out of control and death was imminent.

With surgery, the approach, nutritional optimization, and recovery were fraught with unprecedented unknowns.

The multidisciplinary team quickly convened, consulted thoroughly with the family, and agreed on a phased treatment plan.

1: Establish a Lifeline

After confirming the diagnosis, the inpatient team escalated therapy: broad‑spectrum antibiotics, nutritional support, and transfusion were administered simultaneously to create a window for surgery.

Gastroenterology served as a critical bridge between imaging findings and surgical intervention using precise endoscopic techniques.

In late January, the ultrasound physician performed ultrasound‑guided hepatic cyst puncture and abscess drainage, with bacterial culture of the pus. That same night, given the suspicious communication between the duodenum and hepatic cyst on CT, the Gastroenterology and Endoscopy team performed an emergency gastroscopy and identified key signs: pyloric stenosis and white pus draining into the duodenum.

To confirm the diagnosis, Dr. CHEN Weiwen, Gastroenterology, injected indigo carmine dye through the hepatic cyst drain. The dye was directly visualized flowing into the duodenal bulb, confirming a duodenal fistula. This dye‑tracking technique provided definitive anatomical proof.

Given her advanced age and poor nutritional status, Dr. CHEN also placed a nasojejunal tube endoscopically, bypassing the fistula to reduce infection risk while enabling enteral nutrition. This thin tube allowed Parkinson’s disease medications to be administered via feeding tube instead of orally, becoming a lifeline to preserve brain function and buy time for surgery.

2: Surgical Breakthrough

In early February, as families prepared for Spring Festival reunions, the operating room at JIH hosted a high‑risk operation led by Dr. LI Jun’s surgical team.

Perforation of a duodenal ulcer into a hepatic cyst is extremely rare, compounded by pyloric stenosis that severely impaired eating, nutrition, and medication. The case was critical and complex, with high surgical and postoperative risks.

The surgical team conducted comprehensive preoperative planning:

• Precisely drain hepatic cysts and abscesses to control infection and relieve compression.
• Suture the ulcer perforation to halt disease progression.
• Perform gastrojejunostomy with a large‑bore tube to resolve pyloric stenosis and restore nutrition.

Every step, whether it was infection control, perforation repair, or digestive tract reconstruction, balanced acute rescue and long‑term recovery, minimizing early and late complications.

The successful surgery also depended on the Anesthesiology team.  Mrs. Zhang faced not only Parkinson’s-disease‑related neurotransmitter imbalance but also severe diffuse thyroid enlargement and scoliosis, creating difficult airway anatomy. The team performed a full preoperative evaluation, prepared a detailed plan, and stationed a difficult airway cart.

Dr. CHANG Jing, Anesthesiology, said, “Given thyroid enlargement displacing neck anatomy, we used ultrasound guidance to accurately locate the compressed internal jugular vein and achieved successful one‑pass cannulation.

During maintenance anesthesia, real‑time monitoring of arterial/venous blood pressure, blood gas, and electrolytes ensured stable hemodynamics and internal environment.

Emergence and extubation were smooth. With multimodal analgesia, pain was well‑controlled, and she was safely transferred to the ICU.”

A Delicate Balance: Post-Operative Observation Throughout the Spring Festival

Postoperatively, Mrs. Zhang was admitted to the ICU.

For someone with 35 years of Parkinson’s disease, successful surgery was only the first hurdle. Returning to her preoperative functional status would be a long, grueling challenge. She had been bedridden for 17 days upon ICU admission.

Postoperative stress exacerbated her Parkinsonism: severe rigidity, generalized tremors, and extreme sensitivity to light and sound. As predicted, the biggest obstacle emerged: disordered brain neurotransmitters and chaotic catecholamine release, requiring complete re‑titration of anti‑Parkinson medications.

Parkinson’s disease medications demand extremely precise, individualized timing and dosing. Since Mrs. Zhang could not take oral medications, tablets were crushed and administered via the nasojejunal tube. This route altered absorption and pharmacokinetics: extended‑release formulations lost their effect, and patches proved ineffective.

In advanced Parkinson’s disease:

• Too little drug → severe tremors and rigidity.
• Too much drug → fatal dyskinesia, psychiatric agitation, violent flailing, high risk of renal failure and fractures.

A silent but intense battle unfolded in the ward over the Spring Festival period.

Following Dr. CHEN Yan’s specialized protocol — symptom–time–drug correlation and individualized precision medicine — the ICU and inpatient team maintained a detailed Parkinson’s disease medication diary, recording every dose, timing, and physical response. Day and night, every episode of tremor (graded), dyskinesia (graded), or psychiatric change was documented and shared in real time.

Dr. CHEN gradually titrated the regimen, at one point adjusting doses to one‑eighth of a tablet. A new drug combination restored neurotransmitter balance. Mrs. Zhang achieved eight hours of uninterrupted sleep; psychiatric symptoms resolved, and dyskinesia was well‑controlled, with only mild tremors related to emotional state.

Dr. CHEN noted that the cerebral biochemical battle triggered by general anesthesia and gastrointestinal reconstruction had subsided. As her condition improves, the team aims to resume whole tablets and further optimize therapy.

For infection control, the ICU team used antibiotics only after pathogen identification, selecting agents with low central nervous system toxicity and closely monitoring liver, kidney, and electrolyte levels to prevent antibiotic‑induced encephalopathy in Parkinson’s disease.

Though not acutely unstable in the traditional sense, Mrs. Zhang required prolonged, high‑intensity, meticulous care — especially episodes of psychiatric symptoms and violent movements — presenting an unprecedented challenge for the ICU team, who maintained 24/7 in‑person and online communication with Neurology.

The nursing team also faced extraordinary demands. Due to extreme environmental sensitivity, every procedure was performed slowly and gently. One day, Nurse Clara CHEN helped Mrs. Zhang sit at the bedside for the first time since becoming bedridden. She elevated the head of the bed gradually, pausing to assess response. Terrified, the patient held tightly to Nurse Chen’s arm. Without rushing, she waited patiently until the patient’s breathing calmed. In that moment, Mrs. Zhang completed her first bedside sit-up in the ICU.

Meanwhile, Dr. LI Jun’s surgical team closely monitored abdominal drains and removed them once surgical complications were ruled out. He also advised the team on the timeline for removing the nasoenteric tube.

The Nutrition Department served as the foundation of care, providing fuel for recovery. Initially, enteral tolerance was poor, requiring repeated adjustments to balance energy intake, avoid interference with drug absorption, and preserve gut function. The team also closely evaluated swallowing function to support early removal of the nasogastric tube.

Clinical Nutritionist Helen TAO said, “Mrs. Zhang presented with severe malnutrition and poor tolerance to nutritional formulas on admission. We followed the five‑step nutrition care ladder, transitioning gradually from parenteral to enteral nutrition to meet daily needs while protecting gut function. After thorough postoperative assessment, we encouraged mashed foods plus full nutritional supplements to facilitate early nasogastric tube removal, with ongoing swallowing evaluation. One week later, her oral intake exceeded 85% of daily requirements without aspiration, and her weight began to rise steadily.”

In the later recovery phase, the Rehabilitation team joined the effort. They designed an individualized Parkinson’s-disease‑specific exercise program, starting with passive range‑of‑motion exercises to maintain muscle strength and prevent joint stiffness. Therapists worked bedside daily; as strength improved, Mrs. Zhang began active participation, with good joint mobility achieved.

This wasn’t a one-man show by a single specialty, it was a magnificent team effort by the entire JIH multidisciplinary team.

Spring Blossoms: From Bedridden to Holding A Spoon Again

Neurology stabilized the patient’s brain.

Gastroenterology and General Surgery cleared the infection.

The ICU and inpatient care team maintained the patient’s vital signs.

Nutrition services provided essential fuel for recovery.

After a month of round‑the‑clock dedication, the patient could live her life again.

In early March, as magnolia buds bloomed across Shanghai, Mrs. Zhang welcomed her own spring. Her Parkinson’s disease was again stable, with a new medication regimen tailored to her current condition.

Gone was the woman who rambled incoherently from deep infection and lay bedridden with tubes.

Today’s Mrs. Zhang:

• Stands independently and walks with minimal assistance.
• Holds a spoon and feeds herself.
• Composed a 100‑character poem.

Dr. WEI Meng, Chairman of Internal Medicine at Jiahui International Hospital, said, “Mrs. Zhang’s story vividly embodies Jiahui’s philosophy of whole‑person, full‑cycle healthcare. The complexity of Parkinson’s disease demands not only an elite neurology team but also rapid integration of hospital‑wide resources into a high‑performance multidisciplinary collaborative unit.

This cross‑departmental ‘combined operations’ model enables precise, continuous, compassionate health management even after 35 years of disease.

Jiahui’s international standard is not only advanced technology and equipment, but unwavering commitment to patient‑centered care.”

In early 2026, Mrs. Zhang’s courage and love for life created a legend in the Parkinson’s disease community, inspiring others to face the disease without fear, pursue early scientific management, improve quality of life, and live gracefully with illness — a powerful tribute to World Parkinson’s Day.

Parkinson’s disease is a complex neurodegenerative disorder, a 24‑hour trap restricting movement and mental function. Breaking free requires not only expert neurologists but a high‑level, rigorous healthcare system that mobilizes comprehensive hospital resources for whole‑person management.

Jiahui International Hospital Shanghai has once again demonstrated to the world that truly international medicine means advanced concepts and equipment, above all, unwavering patient‑centered care.

On this special day, we salute Mrs. Zhang for her 35‑year fight against illness, and we honor the Jiahui clinicians who sacrificed Spring Festival reunions to guard life with professionalism and compassion. Together, they show that no matter how long or severe the disease, multidisciplinary collaboration can always light the hope of life.