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

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

Öz

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

Anahtar Kelimeler

• Enteral beslenme, Alternatif beslenme, Postoperatif beslenme

Kaynakça

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