Recenti progressi in medicina · 2025
[Use of parenteral nutrition in a patient undergoing pancreaticoduodenectomy for distal bile duct cancer: rationale and clinical implications].
Клинический случайСтатьяАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Salomone Sara, Pellegrino Luca, Rinaldi Marilena, Casalone Valentina, Witel Gianluca, Borghi Felice
Аннотация
INTRODUCTION: Major pancreatic surgery, such as pancreaticoduodenectomy, often involves patients with compromised nutritional status. Parenteral nutrition (PN) may serve as temporary support while awaiting adequate oral intake.
AIM: This report presents a clinical case to discuss the indications, benefits, and implications of PN within an ERAS-based perioperative management protocol.
CLINICAL CASE: A 71-year-old woman with recent weight loss and a BMI of 18.28 underwent a Whipple procedure for distal biliary tract cancer. Preoperatively, nutritional supplementation with immunonutrients was initiated. Postoperatively, PN was administered via a peripheral venous line using a three-chamber bag, without central venous catheter placement. Oral feeding was gradually resumed, and PN was discontinued on postoperative day 6. The postoperative course was uneventful, with no clinical or surgical complications. The patient was discharged on postoperative day 8. Histological examination revealed in situ intrabiliary neoplasia without pathological lymph node involvement, and no indication for adjuvant therapy. At the 14-day postoperative dietary follow-up, the patient showed a weight gain of 2 kg and adequate nutritional intake.
DISCUSSION: In the setting of high-complexity pancreatic surgery, early and individualized nutritional management is crucial, as recommended by ERAS and ESPEN guidelines.
CONCLUSIONS: In this case, peripheral PN proved to be an effective and safe strategy, avoiding the risks associated with central venous catheter placement. The integrated approach supported a rapid nutritional and clinical recovery.
AIM: This report presents a clinical case to discuss the indications, benefits, and implications of PN within an ERAS-based perioperative management protocol.
CLINICAL CASE: A 71-year-old woman with recent weight loss and a BMI of 18.28 underwent a Whipple procedure for distal biliary tract cancer. Preoperatively, nutritional supplementation with immunonutrients was initiated. Postoperatively, PN was administered via a peripheral venous line using a three-chamber bag, without central venous catheter placement. Oral feeding was gradually resumed, and PN was discontinued on postoperative day 6. The postoperative course was uneventful, with no clinical or surgical complications. The patient was discharged on postoperative day 8. Histological examination revealed in situ intrabiliary neoplasia without pathological lymph node involvement, and no indication for adjuvant therapy. At the 14-day postoperative dietary follow-up, the patient showed a weight gain of 2 kg and adequate nutritional intake.
DISCUSSION: In the setting of high-complexity pancreatic surgery, early and individualized nutritional management is crucial, as recommended by ERAS and ESPEN guidelines.
CONCLUSIONS: In this case, peripheral PN proved to be an effective and safe strategy, avoiding the risks associated with central venous catheter placement. The integrated approach supported a rapid nutritional and clinical recovery.