Clin Nutr Res.  2019 Jul;8(3):247-253. 10.7762/cnr.2019.8.3.247.

Nutritional Management of a Patient with a High-Output Stoma after Extensive Small Bowel Resection to Treat Crohn's Disease

• Lee YJ
• Kweon M
• Park M

• KMID: 2454082
• DOI: http://doi.org/10.7762/cnr.2019.8.3.247

Abstract

For patients with short bowel syndrome who undergo ileostomy, nutritional management is essential to prevent complications associated with a high-output stoma (HOS). We report a practical example of ostomic, medical nutrition therapy provided by an intensive nutritional support team (NST). A 42-year-old male with a history of Crohn's disease visited Seoul National University Hospital for treatment of mechanical ileus. He underwent loop ileostomy after extensive small bowel resection. As his remaining small bowel was only 160 cm in length, the stomal output was about 3,000 mL/day and his body weight fell from 52.4 to 40.3 kg. Given his clinical condition, continuous tube feeding for 24 h was used to promote adaptation of the remnant bowel. Thereafter, an oral diet was initiated and multiple, nutritional educational sessions were offered by dietitians. Constant infusion therapy was prescribed and included in the discharge plan. Two months after discharge, his body weight had increased to 46.6 kg and his hydration status was appropriately maintained. This case suggests that the critical features of medical nutritional therapy for ostomy management are frequent assessments of fluid balance, weight history, and laboratory data and after nutritional interventions.

Keyword

Ileostomy; Short bowel syndrome; Diet therapy; Nutrition therapy

MeSH Terms

Adult
Body Weight
Crohn Disease*
Diet
Diet Therapy
Enteral Nutrition
Humans
Ileostomy
Ileus
Male
Nutrition Therapy
Nutritional Support
Nutritionists
Ostomy
Seoul
Short Bowel Syndrome
Water-Electrolyte Balance

Figure

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  Figure 1 Changes in nutritional intake and body weight after ileostomy. OP, operation; POD, postoperative day; EN, enteral nutrition; PN, parenteral nutrition. *Tube feeding intake; †estimated oral intake; ‡home PN (3times/week) converted into daily.

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