SEVERE INTESTINAL FAILURE IN A CHAGAS’S DISEASE PATIENT AFTER TOTAL COLECTOMY PLUS PARTIAL ILEECTOMY

Abstract

Introduction: To report the clinical course of a Chagas’s disease patient with severe intestinal failure after resection of the total colon and terminal ileum. Case Report: The patient underwent rectosigmoidectomy (of the sigmoid volvulus, December 2009) and total colectomy plus partial ileectomy (May 2011). Patient evolved with multiple hospitalizations caused by severe diarrhea (up to 23 stools/day), hydroelectrolyte disturbance and acute renal failure, severe protein-energy malnutrition [loss of 34.9% of usual body weight (uBW)], and multiple episodes of sepsis. Were prescribed parenteral nutrition solutions exclusively or concurrently with very small volumes (e.g., 40ml/day) of semi-elemental diet with low fat and high protein. After several weeks predetermined amounts of carbohydrate-rich foods (potatoes, rice, pasta, cassava), vegetables (chayote, carrots), low-fat meat, cream crackers, coconut water and fruit (watermelon, melon, banana) were progressively introduced. After 36 months, the patient was metabolically stable (BW=67.2 kg, weight recovery of 23.6 kg), with hydroelectrolytic balance. Due to the recovery of the functional capacity, the patient was advised to return to his work activities.  Conclusions: Chagas’s disease patient submitted to intestinal resection may have severe intestinal failure and protein-energy malnutrition. Specialized nutritional therapy and clinical and laboratory monitoring by a multidisciplinary team, can contribute to better prognostic.