NUTRITIONAL THERAPY IN POST TOTAL HYSTERECTOMY, ADHESIOLYSIS, CHISTEKTOMY, POST LAPARATOMY EXPLORATION EC PERFORATION OF COLON SIGMOID AND COLOSTOMY : A CASE REPORT
Giena Tiara Werdhianti (a), Suryani Asad (b)

a. Clinical Nutrition Specialist Program, Hasanuddin University School of Medicine, Indonesia
b. Department of Nutrition, Hasanuddin University School of Medicine, Indonesia

Abstract

Exploratory laparotomy is generally performed as an emergency procedure in cases of hollow organ perforation. Postoperative complications can occur after both elective and emergency laparotomy. Postoperative pain, nausea, vomiting are common. In the reality, some patients have experience with short and long term complications such as fever, wound infection and dehiscence, anastomotic disorder, adhesive bowel obstruction, incisional hernia, etc. These complications are more common with emergency surgery, but can also occur in elective procedures. The aim of nutritional therapy in postoperative conditions is to minimize inflammatory and improve clinical conditions, fulfill macro and micronutrient needs, advance the healing process, improve the immune system and nutritional status. A 50 years old female diagnosed with post laparatomy exploration ec perforation of colon sigmoid and colostomy, severe protein energy malnutrition (Subjective Global Asessment Score C), anemia (9.8 g/dl), leukopenia (1900 /ul), immune system depletion (Total Lymphocyte Count/TLC 247/ul), hypoalbuminemia (2.4 g/dl), and imbalance electrolyte (natrium 131 mmol/l, kalium 3.1 mmol/l). In the beginning of treatment, the patient was only lie on the bed. Nutritional therapy was given with total energy expenditure 1700 kcal and increased gradually to 1850 kcal, protein 1.5-1.7 g/kgIBW/day, carbohydrates 50%, fat 31.7-33.8%. Supplementation was zinc, vitamin B Complex, vitamin C, vitamin A, curcuma, and snakehead fish extract high content of protein albumin (Pujimin). The patient was discharged after 16 days with clinical and laboratory improvements (Hb 11.6 g/dl, leucoyte 8400/ul, TLC 1255/ul, albumin 3.2 g/dl, natrium 135 mmol/l, kalium 5 mmol/l), and could walk with assistance. In conclusion, adequate nutritional therapy with macronutrient and micronutrient can improve nutritional status and quality of life in post laparotomy exploration.

Keywords: post laparotomy exploration, malnutrition, inflammation, nutritional therapy

Topic: Dietetics and nutrition