A seven-year-old man with a history of arterial hypertension, non-insulin dependent diabetes mellitus, ischemic heart disease and gallstones was admitted to the emergency department for study and treatment of acute abdomen for 6 hours.
The surgical exploration revealed massive necrosis of the distal jejunum, ileum and ascending colon secondary to superior embolism. The patient underwent resection and a viable jejunostomy with proximal ileocolic anastomosis.
A percutaneous gastroduodenal tube was implanted for later Enteral Nutrition (EN).
Postoperative parenteral nutrition (PN) was established in combination with EN first with peptide formula and later with continuous gastrostomy polymeric infusion pump with good tolerance.
The pharmacological treatment consisted of: Digoxina®, anticoagulant (Sintrom®), antidiarrheal (Tanagel®, Fortasec®) and antacid (Ranitidine®).
One month after surgery, the patient was referred to the Nutrition Service of the Virgen de las Nieves Hospital.
The assessment showed a weight of 69.5 kg, a height of 169.5 cm and a BMI of 24.3 kg/m2 (normal weight), showing a decrease in weight of 5 kg postoperatively compared to a total of 13 kg pre-intervention.
A mixed EN was peptidic by gastrostomy and polymeric specific for oral diabetics, totaling a caloric intake of 2,000 kcal/day.
A weekly follow-up was carried out with weight control; subsequently, self-monitoring of blood glucose and a rapid-acting insulin regime were carried out, passing to NPH insulin.
Gastrostomy was maintained for 10 months, with several attempts to transition to astringent oral diet that failed due to diarrhea, weight loss, NE peptidic exclusively to maintain intolerance.
Prior to the removal of the gastrostomy, tolerance to astringent oral diet and to supplements of polymeric formula was achieved, with improvement of bowel habits and weight gain, which allowed total ostomy removal.
Thereafter, the dietary prescription consisted of a stront oral diet crushed with oxalate restriction and supplemented with a specific polymeric formula for diabetics.
During 9 years of follow-up and given the patient's age, the diet progressed to a free character adapting to the patient's tastes and habits, with progressive inclusion of foods such as milk together with periodic alpha-glucosidase (Ker).
During recovery, the patient also presented several complications: Urinary infection, renal and intravesical lithiasis due to hyperoxaluria with several hospital admissions and hemoglobins caused by progressive iron deficiency of the anticoagulant.
Currently the patient continues with periodic reviews.
The relevance of this case is due to the fact that our 87-year-old patient after 10 years of surgery has good nutritional status and good quality of life, adapting his remaining intestine to physiological functions.
