Type IV-A Choledochal cyst

Yashoda. K1*, Meena2

1Deputy Nursing Superintendent, Department of Nursing, Kauvery Hospital, Salem

2Nursing Supervisor, Department of Nursing, Kauvery Hospital, Salem

*Correspondence: M: +91-9500779605; Email: yashodajayavelu@gmail.com

Background

A 16 years aged female presented with complaints of abdominal pain and fever since one week, along with vomiting and giddiness. Similar episode in the past (+). No history of loose stools/constipation.

She was diagnosed to have Choledochal cyst .

The classic triad in adults with choledochal cysts is abdominal pain, Jaundice and palpable abdominal mass in right upper quadrant.

Type IV-A Choledochal cysts are characterized by congenital cystic dilatation of the biliary tree extending to involve the intrahepatic biliary channels also.

 

Case Presentation

Patient had a history of abdominal pain since she was two years old. Parents would take her to a local clinic for treatment after which pain would subside; this they had followed all these years.

Recently she developed fever and vomiting, they visited a consultant who referred him to us for further treatment.

On examination, she was conscious, and her vital parameters were stable.

MRI/MRCP weredone, which showed Type4A choledochal cyst; planned for cyst excision.

Patient underwent Open Hepatico Jejunostomy (a procedure to create a connection between the hepatic duct and the jejunum).

Nursing management

Post operative monitoring

Vital Signs

  • All her vital parameters were stable, no rise in temperature.
  • IV antibiotics administered.

Drain Management

  • Drainage tube and Ryles tube were in place and patent
  • POD 1, removed Ryles tube
  • POD 3, patient was mobilized; no oozing or discharge from surgical site.
  • Patient on urinary catheter

Pain Management

  • Analgesic given via epidural catheter which was removed on 4th
  • POD 2: complained of mild abdominal pain, no vomiting. Encouraged spirometry
  • 5th POD, she was mobilized and physio was given
  • Patient positioned comfortably.

Fluid & Electrolyte Balance

POD 1, IV fluid 125 ml per hour on flow which was reduced to 75 ml per hr.

Nutrition

  • Oral sips of fluid started on POD 1, she tolerated well, no vomiting.
  • 5th POD, soft solid diet, no regurgitation.
  • 6th POD, drain and urinary catheter were removed, patient was able to self-void.

Follow up care –

  • 7th POD, she was discharged without any complains and asked to review in OPD after 5 days.
  • Advised the parents to report immediately if bloating, diarrhea and severe pain occur.

Conclusion

Patient’s general condition improved well and discharged in good condition.

 

Ms. Yashoda. K
DNS, Department of Nursing

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment