A0653 - Patient With Short Bowel Syndrome Discharged Home With Full Oral Intake by Utilizing Medium-Chain Fatty Acids: A Case Report

Eri Kunii, RD, Tomohiro Kurokawa, MD, Fumie Shike, RD, Sachiko Ono, RN, Chiharu Inanuma, RN, Yuri Suzuki, PharmD, Junko Kimura, PharmD, Naomi Kobayashi, , Ayami Komatsu, , Toyoaki Sawano, MD, Akihiko Ozaki, MD, Norio Kanzaki, MD, Tomozo Ejiri, MD
Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan

Introduction: Short bowel syndrome (SBS) requires lifelong use of nutritional therapy for malabsorption associated with extensive small bowel resection. Medium-chain triglyceride (MCT) is a favorable energy source because of its more rapid digestion and absorption than of long-chain fatty acid and absorption through the large intestine. We describe the case of an SBS patient who was discharged on a full oral intake of MCTs and additional foods.

Case Description/Methods: A 78-year-old female had a history of colorectal cancer surgery. She underwent extensive small bowel resection for intestinal necrosis caused by a thrombus of the superior mesenteric artery. The remaining small intestine was the jejunum up to 110 cm from the Treitz ligament, with no residual ileum. The patient was 150 cm tall, weighed 59.0 kg, and had nutritional requirements of 1755 kcal energy and 70 g protein. Oral intake was initiated on postoperative day (POD) 5 in combination with intravenous nutrition. Diarrhea continued at a frequency of 2-5 times/day. Since nutrient uptake was affected due to lack of appetite, we attempted (1) seeking healthy sip feed and other nutritional supplements, (2) adding mainly familiar foods such as natto and yogurt, and (3) ensuring efficient energy intake by adding MCT oil. As nutritional dosage increased, diarrhea events increased to 5-7 times/day, and the patient became anxious about voiding. On POD28, MCT oil was added to ensure sufficient energy intake. To avoid fatty diarrhea, the lipid energy ratio was set at approximately 30%, of which 30%-40% was derived from MCT oil. The frequency of excretion increased from 6 to 13 times/day; bowel habit gradually improved, and the amount of feces per excretion decreased. Food intake also showed gradual improvement, and at the time of discharge, energy intake was 1300 kcal and protein intake was approximately 50 g, which did not meet the required amount, but skeletal muscle mass improved from 15.6 to 16.8 kg and Alb from 2.4 to 2.7 g/dL, and the patient was discharged on POD54.

Discussion: In nutritional management of SBS, the length of the remaining small intestine, location of resected small intestine, and presence/absence of an ileocecal area are important. In this case, the upper small intestine, a high-absorption site, remained, and the patient could consume relatively high-quality protein. Therefore, the use of MCTs, which have high utilization efficiency, increased protein utilization efficiency.


Disclosures:


Eri Kunii, RD, Tomohiro Kurokawa, MD, Fumie Shike, RD, Sachiko Ono, RN, Chiharu Inanuma, RN, Yuri Suzuki, PharmD, Junko Kimura, PharmD, Naomi Kobayashi, , Ayami Komatsu, , Toyoaki Sawano, MD, Akihiko Ozaki, MD, Norio Kanzaki, MD, Tomozo Ejiri, MD. A0653 - Patient With Short Bowel Syndrome Discharged Home With Full Oral Intake by Utilizing Medium-Chain Fatty Acids: A Case Report, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.