Background: A 45-year-old man with a history of chronic alcoholism accompanied by chronic pancreatitis and insulin-dependent diabetes mellitus, who has a very low dietary intake.
Multiple hospital admissions for exacerbations of chronic pancreatitis.
In 2002, she underwent excision of a pancreatic pseudocyst that ended with a cystogastrostomy that resolved favorably.
In February 2003, there was a new pericystic emphysematous admission complicated by a complicated abscess. Consequently, a Pezzer tube was placed for cholecystectomy in a second surgical procedure.
She was discharged with a tube drainage of approximately 500 ml.
In November 2003, the patient came to the surgery department where they requested a qualitative stool examination that resulted in increased fat and food debris, foul smell and pasty consistency.
No treatment was prescribed.
Current illness: Fe de 2004 comes to the emergency department with a 3-month history of bilateral eye pain, redness, stinging, photophobia and decreased visual acuity.
She was admitted to the ophthalmology department for study and treatment.
Pathological examination revealed ulcerative colitis in 10% of the eyes.
In the left eye central corneal ulcer with stromal necrosis and hypnosis and only had light perception.
Imaging tests were negative.
Horseal cultures were negative.
Examinations by otorhinolaryngology, digestive and rheumatology specialists were not significant.
The patient was referred to the Nutrition Unit for weight loss of 16 kilos in the last 6 months.
Nutritional assessment revealed severe calorie and mild protein malnutrition, weight of 52 kg with BMI of 18.2 and loss of 23% of their usual weight in the last 6 months, severe vitamin A circumference of 5.2 mm Resoluble Protein (abg)
Reference value: 0.4-0.8) and vitamin D (Vitamine D: 0, not detected in blood.
Reference value 15-100 ng/ml).
Both vitamin C and B complex vitamins and zinc were normal.
Fecal maladjustment in 24-hour stools revealed mild maladjustment (Nitrogen 2.5 g, fecal fat 6.3 g, and faecal sugars when Pancrea is already treated) in patients without fecal incontinence.
Treatment: The patient's diet was supplemented with hyperproteic and hypercaloric special formulas for diabetics (Resource diabet® 2 beats each day), administered orally the deficit vitamins A tablet (Ncrea).
Establishment plan: March 2004
We evaluated the patient 3 months later and has a BMI of 20, anemia has evolved favorably.
Horseal ulcers have healed and have almost completely recovered visual acuity (right eye 100% and left eye counting fingers (table I).
