Home parenteral nutrition a life-saving therapy in a primary intestinal lymphangiectasia patient affecting the entire GI tract – 3 year follow-up case report
| Autor: | Michal Kloska, Katarzyna Karwowska, Agnieszka Dobrowolska, Marcin A. Kucharski, Dorota Mańkowska-Wierzbicka, Adrianna Wierzbicka, Katarzyna Karmelita-Katulska, Marta Stelmach-Mardas, Katarzyna Iwanik |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Waldmann's disease Asymptomatic Gastroenterology Anasarca Protein-losing gastroenteropathy 03 medical and health sciences 0302 clinical medicine Pathognomonic Internal medicine Case report medicine Primary intestinal lymphangiectasia business.industry Stomach General Medicine medicine.disease Parenteral nutrition Discontinuation Malnutrition medicine.anatomical_structure 030220 oncology & carcinogenesis Etiology 030211 gastroenterology & hepatology Surgery medicine.symptom business Enteral nutrition |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Introduction and Importance Primary intestinal lymphangiectasia (PIL) is a rare protein-losing gastroenteropathy of unknown etiology, characterized by impaired lymphatic vessels drainage. The pathological changes in PIL result in usually localized or diffuse dilatation of intestinal lacteals, leading to leakage of lymphatic fluid rich of proteins, lymphocytes, and immunoglobulins into the intestinal lumen. PIL may be asymptomatic or mildly symptomatic in moderate forms of the disease. In some patients, though, the outcome may be poor or even life-threatening. This case report demonstrates the severity of protein malnutrition, in some cases, and the extent of GI tract affected, requiring to start PN early and the need for its continuation as home parenteral nutrition (HPN). Case presentation We present a case of 39-year-old male with Factor V Leiden deficiency, who presented initially with symptoms of malnutrition and anasarca. The diagnosis was confirmed by histopathological findings pathognomonic for PIL from biopsies of the stomach, small intestine and colon. Clinical discussion The patient was started on low fat, high protein parenteral nutrition from the beginning of the treatment and required a long-term HPN for 3 years, because trials of tapering off and discontinuation of PN led to worsening of the biochemical results and recurrence of symptoms. Patient gradually improved and stabilized with persistent nutritional support. Conclusions The presented case report shows the magnitude of nutritional support (HPN) needed for severe PIL patients. HPN offers PIL patients with poor outcome and life-threatening complications a chance to improve and lead a normal life. Highlights • Primary intestinal lymphangiectasia is a rare protein-losing gastroenteropathy characterized by impaired lymphatic drainage. • In patients with primary intestinal lymphangiectasia (PIL) the outcome may be life-threatening when anasarca occures. • Therapy of low-fat, high medium-chain triglyceride, high protein content has to be implemented in PIL patients. • Home parenteral nutrition offers severe primary intestinal lymphangiectasia patients a chance to lead a normal life. • Aggressive management is necessary in patients with primary intestinal lymphangiectasia with chronic intestinal failure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|