HIGH-FLOW ILEOSTOMY: WHAT IS THE COST OF CONVENTIONAL TREATMENT (EXCLUSIVE TPN) COMPARED TO DISTAL ENTERAL RENUTRITION WITH PARTIAL PARENTERAL NUTRITION? A CASE REPORT

Nutritional management is crucial in surgical patients, especially in cases of complications from high-output enterostomies. Malnutrition and electrolyte imbalances are associated with worse prognoses, with direct implications for surgical management. Nutritional intervention can be enteral, partial parenteral nutrition (PPN), or total parenteral nutrition (TPN). In cases of high-output enterostomies, exclusive TPN may be used. This case describes a 66-year-old patient who underwent rectosigmoidectomy for neoplasia. They developed an abscess and perforation of the small intestine on the 10^th postoperative day (POD), requiring enterectomy, ileostomy, and mucosal fistula. Progressing to high-output enterostomy, unresponsive to clinical treatment, the decision was made to perform effluent reinfusion, along with prehabilitation measures and the use of PPN. In 14 days, the patient was fit for intestinal transit reconstruction, discharged with an exclusive oral diet after 7 days, and achieved normalization of the digestive tract, regaining 10 kg by the 30th POD. The aim is to describe the costs of PPN associated with effluent reinfusion versus TPN (hypothetical case). Energy needs were calculated by the nutrition department, prescribing 550 kcal daily via Olimel N4E (approximately 35% of the needs). One bag of Olimel N4E/day was prescribed for 14 days at a cost of R$ 2,515.38. This supplement is used exclusively for PPN and administered via a peripheral line. Additionally, ascorbic acid (R$1.33) and B complex vitamins (R$2.34) were used daily, totaling R$51.38. These would also be prescribed for TPN. If exclusive TPN were performed, Olimel N7E (R$290.00/unit) and Olimel N9E (R$210.00/unit) would be used. For 1,833 kcal/day, 2 bags/day of TPN would be required. Thus, over 14 days, the cost would be R$8,120.00 with Olimel N7E and R$5,880.00 with Olimel N9E. Additionally, central venous access would be required, costing R$36.89. Therefore, the total cost of PPN was R$2,566.76, while TPN would cost up to R$8,120.00, an increase of 316%. We did not consider the risks and side effects inherent to exclusive TPN, such as electrolyte, glycemic, and immunological disturbances, as well as the risks of central venous access. Thus, the technique of distal enteral re-nutrition, combined with PPN and prehabilitation measures, allowed reconstruction to be performed in a shorter time and with potentially reduced complications, proving to be a safe and cost-effective procedure.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025