“Sindrome de intestino corto + dehiscencia de anastomosis”

Abstract

Short bowel syndrome is a complex clinical entity that occurs due to the decrease of the effective intestinal surface, usually secondary to an extensive intestinal resection that causes clinical, metabolic and / or nutritional alterations. The diagnosis is mainly clinical and the patient, due to the poorly absorptive process, requires nutritional support to maintain their basic requirements.

The present case concerns a female patient, 61 years old, born and resident in Pelileo, divorced, Catholic, homemaker, with a personal surgical history of cholecystectomy performed 19 years ago, Coledocolitiasis 14 years ago solved with ERCP, left strangulated inguinal hernia 18 days ago with resection and anastomosis. The patient does not report a family history or a history of known allergies. Patient attends to Pelileo Basic Hospital due to the elimination of intestinal fluid through a surgical wound, with a bad smell, in moderate quantity, located in left iliac fossa for about 3 days, referring a surgery intervention developed at Pelileo Basic Hospital due to a strangulated left inguinal hernia, as mentioned before, reason why patient attends to the same Hospital for valuation, where it is decided to be referred to the General Teaching Ambato Hospital because of a limited resolutive capacity.

After the evaluation of the patient at HGDA, a surgical intervention was decided and realized, reporting a preoperative diagnosis of Enterocutaneous Fistula and obtaining a post-operative diagnosis of: Wound Dehiscence + Enterocutaneous Fistula + Dehiscence of Anastomosis. After the surgical intervention, the patient evolves with secondary complications due to the development of the anastomotic dehiscence, of the surgery performed in Pelileo, so that patient starts presenting febrile peaks, leukocytosis, reactants of acute phase alteration, and progressive general state deterioration. Because the patient's digestive tract is not viable for administration, digestion and absorption of nutrients, given the presence of an ileostomy, total parenteral nutrition is selected to be administered by a central venous catheter.

The therapeutic plan included: Strict dry diet, strict control of glycemia and diuresis, excreta intake control, antibiotic therapy with Imipenem 500 mg intravenously every 6 hours, ranitidine 50 mg intravenously every 12 hours, fitomenadione 1 ampoule for necessary reasons, ascorbic acid 1 gram intravenously per day, acetylcysteine 300 mg intravenously every 8 hours, enoxaparin 40 mg subcutaneous a day, loperamide 20 mg orally every 8 hours, octreotide 0.1 mg subcutaneous every 8 hours, nebulizations with 1 ml of ipratropium bromide plus 2 ml of 0.9% saline every 6 hours.