Female patient, diagnosed with colonic inertia.
In May 2003, at 46 years old, a total laparoscopic colectomy with ileorectal anastomosis was performed without incidents.
During the postoperative period he presented tachycardia, abdominal pain and hypotension.
An exploratory laparotomy was performed, which showed necrosis of the distal and distal ileum. Resection of the intestine was performed from distal cm to the Treñitz, as well as closure of the rectal stump.
The biopsy reported a small bowel segment with findings consistent with acute ischemic enteropathy.
And fixed with fugies of 4,500 cc/day due to stenosis and protein-caloric malnutrition.
Initially managed with TCPN, nasoenteral feeding was started on postoperative day 12 and exclusive oral feeding was achieved on day 50.
Upon discharge she tolerated well oral regimen with nutritional supplements.
Up to June 2008, the patient had 17 hospitalizations, 4 due to mechanical ileus, all resolved without surgery, and 13 due to episodes of fluid retention secondary to high ostomy outputs 2,000.
On June 26, 2008, the patient was admitted again due to severe sepsis.
Creatininemia of 4.39 mg/dl was found, objectifying creatinine clearance of 30 ml/min. Given the deterioration of renal function and nutritional compromise predominantly caloric with BMI of 14.2 kg/m2 and intestinal transit of patient 3.
The preoperative study included a rigid rectoscopy that showed a rectal stump of 12 cm. The intestinal transit showed 140 cm of small intestine without narrowing and mild loop dilatation.
Suspecting the involvement of the superior mesenteric artery (SMA) and its placement on computed tomography, Doppler ultrasound showed signifcant stenosis (70%) of the SMA, which was resolved by angioplasty.
With the contribution of hypercaloric-hyperproteic regime and NPTC nutritional parameters optimization (albumin: mg/dl) was achieved.
Five weeks after stent placement, the patient was operated.
During the intraoperative period, we measured the remaining bowel with a length of 140 cm. The jejunostomy was performed and a termino-terminal anastomosis and the mechanic bowel were performed.
Then 15 partial transverse sections were made with linear loads of 3.5 mm to section half of the lumen of the intestine in the form of zigzag as described by Kim9.
The fnal length of the small intestine was 180 cm, which added to the rectal stump gives a length of 190 cm to the anus.
1.
Within the events of the post-operative stage, the formation of an intra-abdominal helmet was evidenced, as well as traceability.
Due to the persistence of febrile episodes, an echocardiogram was performed, which showed the presence of septic thrombus in the right atrium, so treatment for bacterial endocarditis was initiated.
The patient was afflicted with progressive increase in oral intake.
On postoperative day 34, TCPN was suspended, achieving adequate electrolyte and nutritional balance exclusively orally.
The intestinal transit study at 98 days post surgery showed no evidence of enterotomy.
Currently in outpatient monitoring, in treatment with loperamide and nutritional supplements, achieving adequate fluid and electrolyte balance, weight gain and a frequency of 5 times a day stools with scarce runoff.
