MINI CASE STUDY – COLECTOMY

ERIN FEJES – DIETETIC INTERN – OSF ST JOSEPH MEDICAL CENTER

PRESENTATION OUTLINE

 Introduce colectomy patient: MM

 Define/describe/MNT for surgical procedure colectomy

 Conclude with MM patient

PATIENT MM

Patient Information:

 Initials: M.M.
Medical History:
 Age/Sex: 66 YOF
 Height/Weight: 5’2”, 184 lbs; (BMI 33.7)  Heartburn/GERD

 Support: Husband  Hyperlipidemia

 Date of Admission: 1/31/18  Osteoarthritis of cervical spine (2012)
 Date of Discharge: 2/15/18  Primary osteoarthritis of right shoulder (2013)
 Attending: Dr. Naour
 Unit: Family Care Center
HOSPITALIZATIONS

 2010: Laparoscopic assisted sigmoid colon resection with lower pelvic anastomosis d/t diverticulitis
 Repair bladder injury from colovesical fistula.
 Takedown splenic flexure.

 2017: UTI w/ hematuria

 2018: Small bowel obstruction
 2018: Scheduled surgery: benign neoplasm of transverse colon
 After seeing gastroenterologist for abdominal pain
 Polyp of descending colon found after colon cancer screening
RECENT ADMISSION

 1/31/18: Scheduled left hemicolectomy with adhesiolysis

 Procedure: Extensive adhesiolysis with resection of ileum.
Left hemicolectomy with lower pelvic anastomosis and a
takedown splenic flexure
WHAT IS A COLECTOMY?

 Colectomy: Resection of part or all of the colon

 Types: total, partial, hemi, procto

 Indications for a colectomy: Colon/rectal cancer (lympth nodes), large polyps, diverticular disease, Inflammatory
Bowel Disease, or persistent bleeding

 Procedures: Conventional open colectomy, laparoscopic, robotic surgery

COLECTOMY – POSSIBLE OUTCOMES

 Stomas:Temporary or permanent stoma

 Risks: bleeding, infection, injury to intestines, bladder, ureter, blood vessels, anastomosis leak, blood clots, hernia,
bowel obstructions
COLECTOMY – AFTER SURGERY

Medical Treatment:
Medical Nutrition Therapy:
 IV fluids for hydration
 Pain medication  Probiotics
 Oral rehydration solutions – prevent dehydration
 Total colectomy, with ileostomy
Post surgery diet:  Focus on adequate fluids – all pts
 Slow progression: low residue – normal diet
 Self-regulated - UCMC
 Chew foods well, eat slowly
 Clear liquids – full liquids – soft to digest - OSF
 Low residue for 6 weeks
COLECTOMY AND NUTRITION SUPPORT

 If the gut works – use it!

 EN before TPN – no difference in morbidity/mortality

 Enteral nutrition
 Growth hormone, Glutamine, short-chain fatty acids, fermentable fiber sources, trophic factors (increase absorption)
M.M. – MEDICAL STATUS AT FIRST RD NOTE
S/p left hemicolectomy x 3 days

 Nutrition Assessment indicated d/t NPO x 3 days, low Braden Score of 17 (nutrition 1)
 NG tube to intermittent suction
 Drain stomach contents, prevent aspiration
 Edema: 1+ L foot, 2+ R foot
 Ivs: D5 with KCl @ 75 mL/hr (90 g dextrose/day)
 Initial Labs: Ca 8.1, Glucose 151
 Initial Medications: Bisacodyl suppository, Zofran
MM STATUS 1ST THROUGH 6TH RD NOTE

 2/2 Clear Liquid Diet – s/p LHC x2 days  2/9 Abdominal discomfort, fever, WBC elevated:
 2/7 Full Liquid Diet abdominal cavity abscess
 Drained by MD
 Bowel fnx 2/6 and NG tube removed
 2/13 Flagyl started for CDiff
 2/9 PICC line inserted as MD wanted to initiate TPN
 Pt did not want TPN, attempted to call MD  2/14 Mechanical Soft Diet

 2/9 Automatically send EE w/ meal  Should have been Soft to Digest Diet
 2/15 D/C
QUESTIONS?
RESOURCES

 http://www.uchospitals.edu/specialties/colorectal/services/colectomy.html#primaryContent
 https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/colectomy_135,52
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796720/
 https://www.mayoclinic.org/testsprocedures/colectomy/about/pac20384631?mc_id=google&campaign=15981508&
geo=9022128&kw=colectomy&ad=233943748232&network=g&sitetarget=&adgroup=19618564276&extension=
&target=kwd729219406&matchtype=p&device=c&account=9798665035&placementsite=minnesota&gclid=Cj0KC
QiA2snUBRDfARIsAIGfpqFB4FiJJIIUK6HD9E6SZKHQHEHDw27BDc1WPnCAMhKdlVvKxizRtsaArarEALw_wcB
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072645/
 Nutrition and Diagnosis-Related Care – Sylvia Escott-Stump