An 80-year-old woman with hypertension, CRF and hypothyroidism.
She was admitted to Geriatrics Department due to cognitive impairment and developed an acute abdomen with septic shock.
Abdominal CT showed free fluid and thickening of the colon wall.
She underwent a total colectomy with terminal ileostomy due to ischemic colitis and ileostomy due to intra-operative bleeding.
Postoperative recovery was favorable with resolution of shock.
She tolerated enteral nutrition (EN), functioning the ileostomy well.
On the 8th postoperative day, in view of the appearance of abdominal drainage, a CT scan was performed, showing hematoma of the surgical bed.
After that, drainage appeared to be irregular, with a flow rate greater than 1,000 cc/d.
The analysis showed: TG 166 mg/dl (in blood: TG 42, albumin 1.8), glucose 100 mg/dL, proteins 0.83 g/dl, amylase 133, cells 145 (bacterial culture negative, M 32%).
1.
TPN and somatostatin 3 mg/12 h i.v. were established.
Drainage output decreased progressively (BQ: TG 3 mg/dl, protein 2.2 g/dl), yielding at 5 days.
Therefore, it was not considered necessary to perform lymphangiography.
NE tolerance is low in fats rich in medium chain fatty acids (MCFA) and hyperproteic, with good.
