P156 - ENTERAL NUTRITION JOURNEY IN A CASE OF PAEDIATRIC INTESTINAL PSEUDOOBSTRUCTION

P156

ENTERAL NUTRITION JOURNEY IN A CASE OF PAEDIATRIC INTESTINAL PSEUDOOBSTRUCTION

A. Can^1,*, E. Akgül², F. E. Kurtipek¹, H. Öztürk¹, S. Sarı¹, B. Dalgıç¹

¹ Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine , ²Department of Nutrition and Dietetics, Gazi University Faculty of Health Sciences, Ankara, Türkiye

Rationale: The problems encountered in the provision of long-term enteral nutrition in a case of paediatric intestinal pseudoobstruction and solutions are discussed here.

Methods: Case report

Results: A 12-year-old male patient presented with complaints of anorexia, dysphagia, vomiting and early satiety.  Nissen fundoplication was performed at the age of 4 years because of reflux unresponsive to medical treatment and sigmoid colon resection was performed at the age of 9 years because of refractory constipation. On physical examination, BMI:17 kg/m2 (-0.84 SDS), dehydrated appearance and abdominal distension. Investigations revealed severe oesophageal dysmotility. He could'nt tolerate oral feeding. The patient could not tolerate both bolus and continuous nasogastric feeding. Because of gastroparesis, a nasojejunal tube (N/J) was placed endoscopically using an endoclip (Figure 1). Since diarrhoea, abdominal pain and distension developed with isocaloric standard enteral formula given continuously, continuous feeding with isocaloric formula rich in peptide-based medium-chain fatty acids was preferred. The targeted energy (1800 kcal/g) was reached gradually in one week without any problems. The patient tolerated continuous feeding with N/J well and surgical jejunostomy was opened 6 weeks later. In the 9-month follow-up of the patient who was fed with jejunostomy, 6 kg weight gain and 4 cm height gain were observed.

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Conclusion: PIPO is a very difficult disease to manage nutritionally. In the long term, approximately one third of patients require nasoenteral nutrition and partial or complete parenteral nutrition (TPN), which increases the risk of mortality and morbidity with complications such as central catheter infection, sepsis, central venous thrombosis. Therefore, it is very important to provide enteral nutrition which is as physiological as possible and multidisciplinary approach.

Disclosure of Interest: None declared