Medical Nutrition Therapy in Ascendens Colon Perforation Due to Intestinal Tuberculosis With Severe Malnutrition: A Case Report

Abstract

ObjectivesIntestinal tuberculosis (TB) cases increased with the increase in TB cases in general. Intestinal TB was found in 11% of extrapulmonary TB patients. Severe malnutrition was associated with poor outcome in TB patients. Due to inflammation process, TB patients were in hypermetabolic conditions which caused increase in nutritional requirements. Intestinal TB with severe malnutrition need spesific nutritional therapy, tailored to each patient based on their nutritional status and clinical condition. MethodsA 41-year old male patient with severe malnutrition (body mass index 17,9 kg/m2) diagnosed with post laparotomy due to perforation of ascending colon due to Intestinal TB. Oral intake decreased due to loss of appetite and abdominal pain. Patient showed pale in conjunctival, loss of subcutaneous fat, wasting and edema in extremities. Laboratory findings were anemia (7.5 g/dL), hypoalbuminemia (2.4 g/dL), hyponatremia (130 mmol/L), hypokalemia (3.0 mmol/L) and severe depletion of total lymphocyte count (477/mL). Patient suffered from post-operative complications in the form of post-operative ileus, low output enterocutaneous fistula and suspected an anastomoses leakage. ResultsMedical nutrition therapy was given with a total calorie of 1175 kcal and increased gradually to 2000 kcal, protein 0.8–2 g/Ideal Body Weight/day using high protein formula and amino acids parenteral nutrition, including glutamine infussion. We administered suplementations which were zinc, multivitamins, curcuma and snakehead fish extract. Patient was discharged after 37 days with clinical and functional capacity improvement assessed with handgrip dynamometer from 11.2 to 23.4 kg. Laboratory improvement were Hemoglobin 10.1 g/dL, Albumin 2.8 mg/dL, Sodium 143 mmol/L, Potassium 4.2 mmol/L and Total lymphocyte count 904/mL. Post-operative complications were improved. ConclusionsMalnourished patient with intestinal TB who undergoing surgery had an increased risk of nutritional deficiencies and postoperative complications. Specific nutritional therapy to reduce inflammation or hypermetabolic, and to treat post surgical complications, proper monitoring and nutritional education results in a good outcome for patient. Funding SourcesThe author(s) received no financial support for the research, autorship and/or publication of this article.