A 33-year-old male, born in Morocco, who resides in Spain intermittently for work reasons.
She was admitted from her country to the emergency department of our hospital for abdominal pain and vomiting.
The patient reported having been admitted in the previous two months due to a suboptimal condition that did not respond to medical treatment.
The report showed that enterolysis was performed after one month of therapeutic fasting without improvement.
Postoperatively, delayed gastric emptying and prolonged ileus had to be reoperated.
An extended right colectomy, gastrojejunal anastomosis, right lateral ileum and left lateral ileum were performed.
The anatomopathological report showed that in the 14 cm of the ileum and 140 cm of the colon removed, some areas of retractile intestine and extensive but peritonous fibrosis were observed, as well as multiple specific mucosal necrosis zones.
After two months of total fasting with intravenous fluid therapy due to intolerance to enteral nutrition (EN), and having lost more than 25 kilos of weight, the patient requested voluntary discharge to Spain.
The patient reported a history of duodenal obstruction since childhood resolved with medical treatment and several surgical interventions: laparoscopy with resection of the volvulus at 13 years of age, duodenal resection with intercostal abscess known as gastroenteroanastomosis wall.
The family history included a brother who died at 39 years of age in an abdominal surgery ( supposedly due to colon cancer without documented autopsy) and an 8-year-old child with conditions that show up as an emergency cancer since childhood
Physical examination revealed poor general condition, severe malnutrition and anasarca, and edema with fovea to the knees.
Abdomen blushing and depressible with diffuse discomfort due to palpation and absent peristalsis.
No signs of peritoneal irritation.
Two stomas had no line content of the midline laparatomy.
Weight 58.6 kg (BMI 16.2 kg/m2).
The rest of the examination and complementary tests were normal, except the analytical parameters.
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She was admitted to the Surgery Department; an aspiration probe was placed, antiemetic and prokinetics were applied, and she began to progressively renutrite with total parenteral nutrition (TPN).
The TPN was maintained for two months until it was transferred to continuous EN, and finally, it was possible to remove the aspiration probe and introduce oral nutrition with the help of prokinetics and hygienic-diethaltic measures favoring.
At 14 weeks of admission he was discharged with a weight of 79 kg (BMI 21.9 kg/m2).
Three months later, the patient returned to the service due to a hyponatremic complementary bedding condition due to increased debt due to a 3-day severe event of ileostomy, which was related to evolution and oral intolerance.
The hydrolytic alterations presented were corrected, and in the presence of oral intolerance, the TPN began on the third day of admission and was maintained for the following three months.
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In the fourth month of the second admission, the patient underwent enterolysis of the entire intestinal package, the previous gastroenteroanastomosis was disassembled, the small intestine was resected an angle of 80-50 cm from the ileocolon.
Two months later, the patient had to be reoperated due to a bad anastomosis. The anterior anastomotic zone was resected with the removal of 12 cm of ileum and a new manual ileo-lateral anastomosis was performed.
Anatomopathological analysis of the mouth of an interstitial ileostomy revealed hyperglossia, all of which were compatible with obscure plexuses, with a decrease in immature ganglia bcl2+ and intraepithelial lymphocytes.
At 8 months she was discharged with malalignment syndrome and chronic steatorrhea secondary to previous interventions. Dietary measures and pancreatic enzymes were prescribed in each ingestion, together with an antidiarrheal demand.
At 18 months she comes to review with excellent general status, normal life, follows the dietetic advice given to her, 2-3 daily non-steatorrheal stools, takes 4-61000K tablets per day of enzyme supplements.
