A 34-year-old Moroccan male patient with a history of previous surgery 8 months before in his country came to the Emergency Department due to asthenia, increased output due to ileostomy of 3-4 days, and oral intolerance.
The reports showed that she had been subjected to enterolysis due to a condition that did not respond to medical treatment.
The left postoperative period showed delayed gastric emptying and prolonged ileus, which had to be operated, performing a right colectomy, anastomosis jejunal anastomosis, enlarged right lateral ileostomy and enlarged lateral gastrojejunal loop.
14 cm of ileum and 140 cm of colon were removed, without finding specific lesions in the pathological study.
The patient reported a history of suboptimal symptoms since childhood of unknown etiology.
Physical examination revealed general malaise, severe mucosal disorientation, positive skinfold sign and mucocutaneous dryness.
Abdomen blushing, of predictable, painful to palpation diffusely without signs of peritoneal irritation.
Stomata in good condition except high output from ileostomy about 2300 cc/day.
Her cardiac and pulmonary auscultation was normal, her BP was 90 mmHg, her HR was 95 bpm, and her temperature was 35.6oC.
Blood, urine and complementary tests were normal.
Subsequently, he was admitted to the Surgery Department, where he began to rehydrate with isotonic IV saline solution, electrolytes and glucose, and high doses of loperamide and loperamide were administered.
On the third day, ileostomy output decreased to 600 cc/day, and after restoration of electrolyte disturbances, and in the presence of oral intolerance of the patient, multiple-elemented multi-element complex NPT was started with a
After 4 weeks with TPN, the patient begins with severe diarrhea and skin lesions.
These lesions are well-defined, pruritic, with erosive plaques with scaling and erythrodermic areas in periorificial areas of the face, perineum, genitals and non-carcassy dermatitis.
It began with the administration of 2 ampoules of zinc iv a day and 1 ampoule of multioligoelemesis was removed from the TPN (26.5 mg/day of zinc), while additional tests were requested.
Gastroscopy did not reveal anything remarkable, and the gastroenterostomy was previously performed in the antrum towards the posterior face.
Performing the dressing, it was visualized in the rectum and along the entire colonic stump, target-like lesions and edematous and very friable mucosa that bleeds with the simple loop enclosed.
Fistulas were ruled out in both segments.
Samples were taken for microbiological studies that were negative and the anatomopathological analysis showed vesicular and chronic inflammation of the intestinal mucosa, with no other relevant data.
48 hours after starting the extra dose of zinc, the dermal lesions spectacularly improved and completely disappeared after seven days, while diarrhea also stopped.
However, plasma zinc levels were barely modified until the fourth week of treatment despite the administered zinc macrodoses.
