Unplanned Alternatives For Enteral Nutrition In Postsurgical Patients: Three Individual Cases

Year 2006, Volume: 13 Issue: 2, 121 - 125, 01.04.2006

S. Savaş Yürüker Koray Topgül A. Ziya Anadol

Abstract

Aim: Enteral nutrition in surgical patients is not only physiological but also cheap. On the contrary, parenteral nutrition is more expensive and has several complications. In this report, we present three different cases in which we had to administer long term parenteral nutrition but somehow could be managed by unique applications of enteral nutrition. Patients and Methods: Three patients (one with pancreas cancer, one with gunshot wound and one with mesenteric vascular disease) were administered different types of enteral nutrition in the postoperative course, between the years 2002 and 2005. The first patient with an unresectable pancreas tumor underwent a hepaticojejunostomy and developed anastomotic leakage. This patient received enteral nutrition from a transhepatically placed jejunal catheter. The second one with mesenteric ischemia received enteral nutrition via a Foley catheter placed into the distal jejunostomy. And the third patient had a gunshot wound. He had persistant duodenal and jejunal multiple leakage with an open abdomen. This patient was also fed with a catheter placed into the distal small bowel. All patients underwent contrast radiographic tests in order to evaluate the patency of the gastrointestinal system prior to enteral nutrition. Results: All postoperative problems could be managed by the advantages of enteral nutrition and the patients were discharged from the hospital uneventfully. Conclusion: In complicated surgical patients, even though the conditions are tough, maximum effort must be done to use the enteral path for nutrition. This will not only minimize the risk for complications but also prevent mortality. Key words: Enteral nutrition, Alternative nutrition, Postoperative nutrition.

Keywords

Enteral nutrition, Alternative nutrition, Postoperative nutrition.

Cerrahi Sonrası Planlanmamış Enteral Beslenme Seçenekleri: Üç Farklı Olgu

Abstract

Amaç: Cerrahi hastalarda enteral beslenme, hem fizyolojik hem de ucuz bir yöntemdir. Parenteral beslenme ise komplikasyonları fazla ve pahalı bir yoldur. Biz bu çalışmada uzun süreli parenteral besleme uygulamak zorunda kalacağımız üç farklı olguda, uyguladığımız değişik enteral beslenme yöntemlerini sunmayı amaçladık. Hastalar ve Yöntem: 2002-2005 yıllarında pankreas kanseri, ateşli silah yaralanması ve mezenter iskemisi nedeniyle ameliyat olan üç hastaya enteral beslenme için alternatif yöntemler uygulandı. Rezeke edilemeyen ve hepatikojejunostomi uygulanıp, anastomoz kaçağı olan pankreas başı kanserli hastada transhepatik olarak jejenuma yerleştirilen kateterden enteral beslenme uygulandı. Segmenter mezenterik iskemi nedeniyle proksimal segmental jejenum rezeksiyonu uygulanan hastaya, distal jejunostomiden Foley kateter ile beslenme sağlandı. Ateşli silah yaralanması sonrası, tekrarlayan duodenal ve jejenum kaçağı olan ve takibinde fistülleri gelişen hastada, açık karın ve primer onarımlarla birlikte distal barsak içine yerleştirilen kateter ile enteral yoldan beslenme uygulandı. Üç olguda da enteral beslenme öncesi kontrastlı tetkiklerle barsakların ve fistül veya kaçakların durumu ve düzeyleri değerlendirilerek tedavi ve beslenme planlandı. Bulgular: Hastaların postoperatif dönemlerindeki sorunları enteral beslenmenin avantajları ile aşıldı. Üç hasta da, bu dönemde sistemik komplikasyonlar gelişmeden, katabolik faza geçmeden taburcu edilebildi. Sonuç: Komplike cerrahi hastalarda, şartlar çok uygun olmasa da enteral beslenme yolu zorlanmalıdır. Böylece komplikasyon oranlarını azaltılabileceği gibi mortalite de önlenebilir. Anahtar kelimeler: Enteral beslenme, Alternatif beslenme, Postoperatif beslenme

Keywords

Enteral beslenme, Alternatif beslenme, Postoperatif beslenme

References

• Gramlich L, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004;20(10):843-8.
• Al-Omran M, Groof A, Wilke D.Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev. 2003;(1):CD002837.
• Ward N. Nutrition support to patients undergoing gastrointestinal surgery. Nutr J. 2003 1;2:18.
• Torosian MH. Perioperative nutrition support for patients undergoing gastrointestinal
• surgery: critical analysis and recommendations. World J Surg 1999; 23:565–9.
• Kirby DF, Delegge MH, Fleming CR.American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology 1995;108(4):1282-301.
• Marks JM, Ponsky JL.Access routes for enteral nutrition. Gastroenterologist 1995; 3(2):130-40.
• Gabor S, Renner H, Matzi V, Ratzenhofer B, Lindenmann J, Sankin O, Pinter H, Maier A, Smolle J, Smolle-Juttner FM.Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nut 2005; 93(4):509-13
• Slagt C, Innes R, Bihari D, Lawrence J, Shehabi Y.A novel method for insertion of post-pyloric feeding tubes at the bedside without endoscopic or fluoroscopic assistance: a prospective study. Intensive Care Med 2004; 30(1):103-7.
• Bistrian BR, Blackburn GL, Hallowell E, et al. Protein status of general surgical patients. JAMA 1974; 230:858-60.
• Hill GL, Pickford I, Young GA, et al . Malnutrition in surgical patients: An unrecognized problem. Lancet 1977; 26;1(8013):689-92.
• Albert E. About a new method for a jejunostomy. 1894. Nutrition 1991; 7(4):244-7.
• Studley HO.Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp 2001;16(4):141-3
• Sando K, Okada A. History of progress in nutritional assessment. Nippon Geka Gakkai Zasshi 1998; 99(3):144-53. .
• Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005; 28(10):2367-71.
• Varga P, Griffiths R, Chiolero R, Nitenberg G, Leverve X, Pertkiewicz M, Roth E, Wernerman J, Pichard C, Preiser JC.Is parenteral nutrition guilty? Intensive Care Med 2003; 29(11):1861-4.
• Sand J, Luostarinen M, Matikainen M Enteral or parenteral feeding after total
• gastrectomy: a prospective randomized pilot study. Eur J Surg 1997; 163:761–6.
• Chin KF, Townsend S, Wong W, Miller GV. A prospective cohort study of feeding needle catheter jejunostomy in an upper gastrointestinal surgical unit. Clin Nutr. 2004; 23(4):691-6.
• Sobotka L. Basic In Clinical Nutrition ESPEN,2000.
• Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK.Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004; 20(10):843-8.
• Dervenis C, Avgerinos C, Lytras D, Delis S. Benefits and limitations of enteral nutrition in the early postoperative period. Langenbecks Arch Surg. 2003; 387(11- 12):441-9.
• Fein BI, Holt PR.Hepatobiliary complications of total parenteral nutrition. J Clin Gastroenterol. 1994;18(1):62-6.
• VA TPN Cooperative Study. Perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991;325:525-32.
• Brandtzaeg P, Halstensen TS, Kett K, et al. İmmunobiology and immunopatology of human gut mucosa: humoral immunity and intraepitelial lymphocytes. Gastroenterology 1989;97:1562-84.
• Li J, Gocinski B, Langkamp-Henken B, et al. Effect of parenteral and enteral nutrition on gut-associated lymphoid tissue. J Trauma 1995; 39:44-52.
• Nirgiotis JG, Andrassy RJ. Bacterial translocation. In: Borlase BC, Bell SJ, Blackburn GL, Forse RA, eds. Enteral Nutrition. Chapman & Hall. 1994:15-24.