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Parenteral Nutrition Support of a Patient With Chronic Mesenteric Artery Occlusive Disease
Author(s) -
Mueller Charles,
Borriello Raffaele,
PerlovAntzis Lea
Publication year - 1993
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/011542659300800273
Subject(s) - medicine , bowel infarction , parenteral nutrition , short bowel syndrome , infarction , mesenteric ischemia , surgery , ischemia , sepsis , myocardial infarction , coronary artery disease , catheter , bowel resection , superior mesenteric artery , cardiology
Vascular catastrophe resulting in a bowel infarction requiring massive resection is one of the most common indications for long‐term total parenteral nutrition (TPN). The causes of mesenteric artery disease include embolic and thrombotic occlusions, nonocclusive mesenteric ischemia, and chronic mesenteric ischemia. This paper describes a case of a patient with chronic ischemia. The indication for TPN was intestinal angina limiting oral intake, not short‐bowel syndrome as a result of bowel infarction and surgery. The patient had an extensive history of atherosclerotic disease and abdominal symptoms. Her nutritional status was maintained with TPN and oral intake as symptomatically tolerated. She eventually developed catheter sepsis. Her cardiopulmonary status deteriorated and she died. Progressive mesenteric ischemia and possible infarction may have contributed to her death. The patient had indicated she did not want surgery for a bowel infarction. She did consent to surgical correction of her disease, if feasible. Although TPN can maintain the nutritional and metabolic status of a patient with chronic mesenteric ischemia, the associated risk of catheter sepsis emphasizes the necessity for expedient treatment of the primary pathology.