Leyva-Martínez, SFernández-Lloret, SMartín-Ruiz, J L2012-11-222012-11-222007-09Leyva-Martínez S, Fernández-Lloret S, Martín-Ruiz JL. Resección intestinal masiva. Proceso de adaptación nutricional. Nutr Hosp; 22(5):616-200212-1611http://hdl.handle.net/10668/643Case Reports; English Abstract; Journal Article;Introducción: La resección masiva de intestino delgado (RMID) con remanente inferior a los 60 cm de yeyuno ocasiona una grave depleción hidroelectrolítico-vitamínica y calórico-proteica. En espera de trasplante intestinal viable la mayoría de RMID dependen de la Nutrición Parenteral (NPT). Caso clínico: Varón de 32 años. RMID por traumatismo seccionante de la raíz de la arteria mesentérica superior. En primera intervención de urgencia : yeyunostomía con resección de I. Delgado, colon derecho y bazo. A los 6 meses: anastomosis yeyunocólica con remanente yeyunal de 12 cm y colecistectomía profiláctica. Actuación nutricional: 1ª fase.— Estabilización hemodinámica y estimulación enteral (6 meses): NPT + Nutrición Enteral con fórmula elemental + solución oral glucohidroelectrolítica (SOGH) + 15 g/d de glutamina oral + omeprazol. Indicadores de progresión: bioquímica, balance I/P. 2ª fase.—Adaptación digestiva con integración del colon (8 meses): Sustitución de NPT por NP Periférica a tiempo parcial. Dieta culinaria progresiva asociada a polienzimático pancreático, omeprazol, SOGH, glutamina, fórmula elemental. Indicadores de progresión: bioquímica, diuresis, peso y deposiciones. 3ª fase. Autosuficiencia sin dependencia parenteral: Dieta oral libre fragmentada asociada a polienzimático pancreático, bebidas mineralizadas, complemento enteral de fórmula, suplementos orales de Ca y Mg, polivitamínico-mineral oral, vitamina B12 im/mensual. Situación actual (52 meses de evolución): Ligera ganancia ponderal, diuresis > litro/día, 2-3 deposiciones normales, sin signos clínicos de deficiencias y valores de micronutrientes en sangre normales. Conclusión: Prescindir de la NP en RMID es posible considerando, como en este caso, una edad y etiología no desfavorables, y la precoz aplicación de un protocolo de adaptación del remanente adecuado.INTRODUCTION Massive small bowel resection (MSBR) with a remnant jejunum shorter than 60 cm produces severe water, electrolytes, vitamins and protein-caloric depletion. While waiting for a viable intestinal transplantation, most of MSBR patients depend on total parenteral nutrition (TPN). CLINICAL CASE 32 years old male, with MSBR due to sectioning trauma of the superior mesenteric artery root. First surgical intervention: jejunostomy with small bowel, right colon, and spleen resection. Six months later: jejunocolic anastomosis with 12-cm long jejunum remnant and prophylactic cholecystectomy. NUTRITIONAL INTERVENTION: 1st phase. Hemodynamic stabilization and enteral stimulation (6 months): TPN + enteral nutrition with elemental formula + oral glucohydroelectrolitic solution (OGHS) + 15 g/d of oral glutamine + omeprazol. Clinical course indicators: biochemistry, I/L balance. 2a phase. Digestive adaptation with colonic integration (8 months): replacement of TPN by part-time peripheral PN. Progressive cooked diet complemented with pancreatic poly-enzyme preparation, omeprazol, OGHS, glutamine, elemental formula. Clinical course indicators: biochemistry, diuresis, weight and feces. 3a phase. Auto-sufficiency without parenteral dependence: fragmented free oral diet supplemented with pancreatic poly-enzyme preparation, mineralized beverages, enteral formula supplement, Ca and Mg oral supplements, oral multivitamin and mineral preparation, monthly IM vitamin B12. Current situation actual (52 months): slight ponderal gain, diuresis > liter/day, 2-3 normal feces, no clinical signs of any deficiency and normal blood levels of micronutrients. CONCLUSION It may be possible to withdraw from PN in MSBR considering, as in this case, favorable age and etiology and early implementation of an appropriate protocol of remnant adaptation.spaResecciónAdaptación nutricionalCholecystectomyMassive resectionNutritional adaptationDiuresisNutrición EnteralFluidoterapiaAlimentos FormuladosHumanosYeyunostomíaYeyunoMasculinoArteria Mesentérica SuperiorNutritional SupportNutrición ParenteralShort Bowel SyndromeSplenectomyTraumatismos AbdominalesAdultoAnastomosis QuirúrgicaColonTerapia CombinadaMedical Subject Headings::Named Groups::Persons::Age Groups::AdultMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Anastomosis, SurgicalMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Surgical Procedures, Minimally Invasive::Endoscopy::Laparoscopy::Cholecystectomy, LaparoscopicMedical Subject Headings::Anatomy::Digestive System::Gastrointestinal Tract::Lower Gastrointestinal Tract::Intestine, Large::ColonMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Combined Modality TherapyMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Urinary Tract Physiological Phenomena::Urinary Tract Physiological Processes::DiuresisMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Nutritional Support::Enteral NutritionMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Fluid TherapyMedical Subject Headings::Technology, Industry, Agriculture::Food and Beverages::Food::Foods, Specialized::Food, FormulatedMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures::Enterostomy::JejunostomyMedical Subject Headings::Anatomy::Digestive System::Gastrointestinal Tract::Intestines::Intestine, Small::JejunumMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Anatomy::Cardiovascular System::Blood Vessels::Arteries::Mesenteric Arteries::Mesenteric Artery, SuperiorMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Nutritional SupportMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Nutritional Support::Parenteral NutritionMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications::Short Bowel SyndromeMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::SplenectomyMedical Subject Headings::Diseases::Wounds and Injuries::Abdominal Injuriesresearch article17970549open access1699-5198