Semi-elemental diet is effective in managing high output ileostomy; a case report

Suhaib Js Ahmad, Asad Khan, Ravi Madhotra, Aristomenis K Exadaktylos, Maria Elena Milioto, George Macfaul, Kamran Rostami, Suhaib Js Ahmad, Asad Khan, Ravi Madhotra, Aristomenis K Exadaktylos, Maria Elena Milioto, George Macfaul, Kamran Rostami

Abstract

A notable proportion of surgically created stomas develop high output. Ongoing monitoring and treatment of hight stoma output is imperative to avoid risk of complications. Prevailing management guidelines focus mainly on supportive measures and medications that alter bowel motility. However, some patients fail to respond to these measures, leaving few substitutes. This report documents the use of semi-elemental diet in the management of a high-output ileostomy case. A 58-year-old patient underwent multiple bowel resections that resulted in a small intestine measuring 90 cm, with an end ileostomy being performed. He was on home parenteral nutrition (HPN) for over 9 years and was admitted to the hospital with an episode of sepsis from an infected line. One day prior to the hospital admission, the stoma was producing 7.2 litres/day. The Patient was advised to start Vital 1.5 10-15/day (2.5-3 litres/day) exclusively, in addition to his 1.5 litres of IV fluid, based on the nutritional requirement as calculated by a dietitian. Following the introduction of the semi-elemental diet, the ileostomy output dropped swiftly to 2 litres/day, 9 days post admission, and the BMI remained stable. This report suggests a possible role for semi-elemental diet in the management of ileostomies with short bowel syndrome. Based on our previous experience and this case, elemental or semi-elemental diet may both be used as a mono-therapy, in patients with high ileostomy output, even in cases with small bowel length as short as 90cm.

Keywords: Elemental diet; High-output stoma; Ileostomy; Short bowel; Ulcerative colitis.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Fluid Input vs Output Fluid balance Chart
Figure 2
Figure 2
Fluid Balance Variance Chart

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