Abstract
Objective: This case report aimed to share our clinical practice about the Partially Hydrolysed Guar Gum (PHGG) incorporation in conventional ileostomy management.
 Case presentation: Patients A and B, who diagnosed with Diabetic Mellitus and Hypertension recto-sigmoid adenocarcinoma stage III, had high stoma output after anterior resection with covering ileostomy (more than 1200ml per day). PHGG was integrated into nutritional management and showed a positive effect in normalizing volume and the consistency of ileostomy stoma output.
 Discussion: Postoperative ileostomy patients often faced a higher risk for malnutrition among cancer patients. Persistent high stoma output without proper management could cause dehydration, depletion of magnesium and sodium, acute renal injury and malnutrition. High protein and high calories normal diet would normally be prescribed to postoperative colorectal cancer patients with an ileostomy. The addition of PHGG showed a positive effect in improving ileostomy consistency and output.
 Conclusion: The PHGG incorporation in the post-operative nutritional management for ileostomy revealed positive outcomes in consistency and volume of stoma output and nutritional intake.
Highlights
Post-operative colorectal cancer patients with covering ileostomy often faced a risk of malnutrition because of resection of the colon and high output of stoma in the early post-operative stage.[1,2]
This case series aimed to share our clinical practice about the Partially hydrolyzed guar gum (PHGG) incorporation in conventional ileostomy management
The current case report revealed that PHGG improved the consistency and volume of the ileostomy output and prevent complications triggered by the high stoma output
Summary
Post-operative colorectal cancer patients with covering ileostomy often faced a risk of malnutrition because of resection of the colon and high output of stoma in the early post-operative stage.[1,2] The poor management of high-output stomas could cause dehydration, acute kidney injury, and malnutrition.[1]. Patient B, a 66-year-old male with comorbid of diabetic mellitus, hypertension, and cerebrovascular accident, was diagnosed for a low rectal adenocarcinoma Stage T3N0M0. He underwent a neoadjuvant pelvic radiotherapy (long course of 5 weeks). Percentage of weight loss was 4.2% before surgery He had an elective anterior resection with covering ileostomy which was fashioned 15 cm from the ileocecal junction. He was started with a clear fluid 6 h post-operative, followed by high-protein high calories diabetic low fiber non-caffeine diet on day 1 post-operative. Patients’ total daily energy [Figure 2] and protein intake [Figure 3] were increasing in trend
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