STRICTURES, STOMAS, AND STARVATION: MULTIDISCIPLINARY APPROACHES IN SURGICAL CROHN'S CARE drjanechuah@gmail.com

342-06

STRICTURES, STOMAS, AND STARVATION: MULTIDISCIPLINARY APPROACHES IN SURGICAL CROHN'S CARE

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Malaysia

Oral or Poster

To explore the nutritional chalenges in a patient post-bowel resection for Crohn’s disease with a jejunal stricture, complicated by high proximal stoma output and intestinal failure. This case highlights the difficulty in maintaining nutritional balance and examines the role of parenteral nutrition, modified chyme reinfusion and distal loop feeding techniques in optimizing postoperative care and recovery in a Crohn's patient.

A 60-year-old male with intestinal obstruction secondary to jejunal stricture underwent bowel resection with a double barrel stoma. The proximal stoma, 50 cm from the DJ flexure, resulted in high-output fluid and protein losses, leading to severe malnutrition (BMI dropped from 18 to 13) and complications including pneumonia, stoma retraction, catheter related infections and stormy ICU admissions. A tailored nutritional approach was employed, including parenteral nutrition and distal loop feeding. A modified technique was developed to enhance distal loop feeding efficiency, minimize leakage, and prevent tube blockage, facilitating improved chyme reinfusion and intestinal absorption during the patient’s critical recovery phase.

After 8 weeks of intensive rehabilitation involving distal loop feeding, chyme reinfusion, parenteral nutrition,and active physiotherapy, along with coordinated care from dietitians, pharmacists, doctors, surgeons, and nurses, he successfuly underwent stoma reversal and was discharged following a 6-month hospital stay.

A modified technique of chyme reinfusion and distal loop feeding, combined with parenteral nutrition, significantly improved outcomes in a patient with high proximal stoma output, enabling nutritional recovery, reversal surgery and discharge. This approach highlights the importance of individualized, multidisciplinary management in complex postoperative Crohn’s disease cases