A 54-year-old man with a history of atrial fibrillation develops severe abdominal pain during lunch causing him to double over. He is taken to the emergency department of a local hospital where an acute abdomen is diagnosed. At emergency exploratory laparotomy an embolism is found in the superior mesenteric artery. The distal 200 cm of small intestine is gangrenous and resected. An additional 100 cm of intestine is dusky in appearance but viable. An ileostomy is created and the patient is admitted to the surgical intensive care unit. How should nutritional management be approached in this patient?
Gastroenterology Division, Northwestern University Medical School, Feinberg School of Medicine, Chicago, Illinois
Address requests for reprints to: Alan L. Buchman, MD, MSPH, Gastroenterology Department, Northwestern University Medical School, Feinberg School of Medicine, Chicago, Illinois 60611; fax: (312) 695-3999.
Dr Buchman is a Consultant for and on the Speaker’s Bureau of Serono. He receives research support from and was a Consultant for NPS/Allelix.
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