SC6 - NUTRITIONAL MANAGEMENT FOR PERFORATED SMALL BOWEL TUMOR SECONDARY TO DIFFUSE LARGE B-CELL LYMPHOMA IN OUT-PATIENT CLINIC: A CASE STUDY Nurul Huda Shamsuri

Nurul Huda Shamsuri1, Lina Isnin2, Jazlina Syahrul1, Zalina Abu Zaid1, Er Ying Ting1

 

1Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.

2Department of Dietetics and Catering, Hospital Melaka.

 

Assessment

Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma associated with perforation involving the gastrointestinal (GI) tract, which may result in malnutrition, severe complications or even death.

  

Patient is a 36-year-old diagnosed with DLBCL since 2016, complete 10 cycle chemotherapy however, relapse in December 2020 and restart 1st cycle chemotherapy on January 2021. Patient had history of emergency closure of perforation site and loop ileostomy for perforated small bowel tumor.

  

Patient’s BMI is underweight with weight and height were 37.8kg and 1.45m respectively. Patient had 20% severe weight loss within 2 months. Biochemical data showed low hemoglobin, albumin, total protein as well as low urea, creatinine and electrolytes. Currently claimed having positional headache, good appetite but early satiety. Patient is moderately malnourished with PG-SGA grade B with loss of muscle in thigh and calf area and estimated of 1200-1500ml per 24 hours of stoma output with frequency of 6x changing ileostomy bags. Dietary assessment showed that patient had achieved 94% energy and 91% protein adequacy.

 

Diagnosis

Altered gastrointestinal function related to decrease functional length of gastrointestinal tract as evidence by weight loss of 20% within 2 months and high stoma output.

 

Intervention

Energy and protein prescribed were 1876kcal (40kcal/kgIBW) and 75g protein (1.6g/kgIBW). Patient was prescribed with 30% ONS (immunonutrition formula) and another 70% from solid food. Education on neutropenic diet and tips to increase energy intake with stoma care were given.

 

After visit, patient consistently achieved her energy and protein intake with adequacy of 107-139%. However, despite on high energy and protein prescription, patient still losing weight which might indicate malabsorption due to physiological cause of high stoma output. Thus, semi-elemental formula was prescribed to optimized patient’s nutrients absorption.

 

Monitoring & Evaluation

Patient's condition monitored through weekly phone call for aggressive nutrition intervention and prevention of another episodes of weight loss.