Nursing care for a patient with multiple organ fistulas and severe malnutrition-sarcopenia syndrome following surgery for irradiated rectal cancer: a case report.

This case report presented a unique, integrated nursing management strategy for a 47-year-old male with extreme complexity arising from radiation-induced enterovesical fistula and severe malnutrition-sarcopenia syndrome following irradiated rectal cancer surgery, addressing a critical literature gap in systematic protocols for high-mortality cases. It demonstrated the practical application and sequencing of advanced, refined interventions within a Damage Control Surgery (DCS) framework, offering a replicable model. Key admission findings included severe metabolic derangement (BMI 13.2 kg/m2, serum albumin 20 g/L, handgrip strength 12 kg), uncontrolled intra-abdominal and gluteal abscesses with multidrug-resistant organisms, complex skin integrity issues (chronic sacrococcygeal pressure injury, incontinence-associated dermatitis), and anatomical complications (presacral abscess, small bowel dilation of 9.87 × 9.86 cm, right ureteric obstruction). Primary diagnoses were radiation-induced multivisceral fistula, severe malnutrition-sarcopenia, and intra-abdominal infection. A phased, MDT-driven approach included: infection control via dual-catheter negative pressure irrigation; nutritional rehabilitation using a stepwise protocol from parenteral to enteral nutrition (short-peptide formula) guided by precise energy calculation and managed with a "ten-aspect" strategy; advanced wound care combining recombinant human epidermal growth factor (rh-EGF) gel with silver ion dressings; and comprehensive functional rehabilitation through a personalized graded exercise prescription, including respiratory training via balloon blowing exercises enhanced by motivational tools (e.g., hanging inflated balloons bedside for engagement). Outcomes after 118 days showed substantial improvement: nutritional and metabolic recovery (weight increased from 38 kg to 41 kg, albumin rose to 35 g/L, electrolyte imbalances corrected); infection resolution (drainage cultures negative, abscesses resolved, bowel dilation reduced to 3.4 × 3.5 cm); physical function restoration (handgrip strength improved from 12 kg to 25 kg, patient progressed from bedbound to ambulating 2 h daily); and complete wound healing. The paramount lesson was that successful management required a systematic, phased, MDT-based nursing model integrating advanced technical interventions with meticulous, protocol-driven supportive care (e.g., structured nutrition and rehabilitation), proving critical for transforming prognosis in similar complex scenarios.