Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antara
ileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnya
dibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasma
stadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna.
Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkan
gangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saat
ini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomi
high output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasi
malnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditas
dan mortalitas pasien ileostomi high output. Empat pasien ileostomi high output
dengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selama
perawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan,
sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasi
akibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomi
high output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatan
stoma. Berdasarkan kriteria malnutrisi American Society for Parenteral and
Enteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapi
medik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecil
namun sering, restriksi cairan hipotonik, pemberian minuman berupa larutan
elektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan dan
elektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi dan
protein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan,
keempat pasien mengalami penurunan output ileostomi, serta perbaikan
keseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinis
dan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengan
kondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saat
perawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karena
komplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnya
meninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaiki
kadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasien
ileostomi high output.
Ileostomy is a surgical procedure to divert the ileum onto an artificial opening in
the abdominal wall, aimed for fecal diversion. Ileostomy is commonly created in
patients undergoing treatment for colorectal cancer, advanced neoplasms with
intestinal infiltration, or gastrointestinal inflammation. High output ileostomy
(stoma output >1500 mL per day) can cause imbalance of fluid and electrolytes,
and malnutrition in patients. At present, there is no comprehensive nutrition
management guideline for high output ileostomy patients. This case series aimed
to support therapy, prevent malnutrition, improve clinical condition, as well as to
reduce the morbidity and mortality of high output ileostomy patients. Four high
output ileostomy patients, with a range of age 42 to 50 years old received medical
nutrition therapy during their hospital stay. Three cases were chronic cases in
malignancy, while the other case was an acute case of adhesion and perforation due
to strangulated femoral hernia. All four cases were early onset high output
ileostomy, occurring in three weeks after stoma creation. Based on the American
Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, these
four patients were classified as severe malnutrition. Medical nutrition therapy was
administered according to a set of principles: small frequent feeding and drinking,
hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotility
medication administration, as well as fluid and serum electrolyte
correction, according to patients' needs and clinical conditions. The target of energy
and protein intake in all patients were achieved during hospital stay. During hospital
monitoring, decreased ileostomy output as well as improvement in fluid and
electrolyte balance were observed in all patients. One patient clinically worsened
and died due to sepsis on the 18th day of hospital stay. Three patients showed
improvement in clinical condition and were discharged. One patient experienced an
increase in ileostomy output at home, and then readmitted ten days after hospital
discharge due to severe anemia and electrolyte imbalance and subsequently died.
Medical nutrition therapy may decrease output as well as improve fluid and
electrolyte balance in patients with high output ileostomy.
SP-Eleonora Mitaning Christy.pdf :: Unduh