Manajemen Nutrisi Pascaoperasi melalui Jejunostomi pada Lansia dengan Perforasi Duodenum di Instalasi Rawat Intensif: Case Report

https://doi.org/10.22146/jkkk.104934

Nur Putri Madany(1*), Sri Setiyarini(2), Sri Widhiastuti(3)

(1) Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada
(2) Departemen Keperawatan Dasar dan Emergensi, Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada
(3) Instalasi Rawat Intensif, Rumah Sakit Umum Pusat Dr. Sardjito
(*) Corresponding Author

Abstract


Background: Duodenal perforation is a rare and life-threatening condition. Hence, postoperative nutritional management is challenging, especially in elderly with severe perforation. Enteral nutrition via jejunostomy is used in this case. Unfortunately, there are limited case studies related to nutritional management, specifically through jejunostomy, in elderly patients with duodenal perforation.
Objective: To understand nutritional management via jejunostomy in elderly patients with duodenal perforation.
Case report: A 72-year-old female patient with duodenal perforation underwent operations and jejunostomy placement. The initial phase relied on parenteral nutrition. Enteral nutrition via jejunostomy was given gradually and adjusted based on enteral tolerance.
Outcome: Evaluation showed that there was enteral feeding intolerance characterized by increased intraduodenal drainage and diarrhea. Adjustments in nutritional administration were applied until enteral tolerance improved. However, the patient's metabolic condition was worsened, causing mortality.
Conclusion: Nutritional management through jejunostomy in elderly patients with duodenal perforation faces challenges in achieving enteral tolerance despite adjustments in the nutritional administration. Enteral feeding intolerance is influenced by advanced age, severity of perforation, and comorbidities, which are also factors in patient mortality. Further research is needed to provide evidence-based guidelines for nutritional management via jejunostomy in patients with duodenal perforation.

INTISARI

Latar belakang: Perforasi duodenum merupakan kondisi yang jarang terjadi, tetapi mengancam jiwa. Manajemen nutrisi pascaoperasi menjadi tantangan, terutama pada pasien lansia dengan perforasi yang parah. Nutrisi enteral melalui tindakan jejunostomi digunakan pada kasus seperti ini. Sayangnya, belum banyak studi kasus terkait manajemen nutrisi, khususnya melalui jejunostomi pada pasien lansia dengan perforasi duodenum.
Tujuan: Laporan ini bertujuan untuk mengetahui manajemen nutrisi melalui jejunostomi pada pasien lansia dengan perforasi duodenum.
Laporan kasus: Pasien perempuan berusia 72 tahun dengan perforasi duodenum menjalani dua kali operasi dan pemasangan jejunostomi. Fase awal mengandalkan nutrisi parenteral. Nutrisi enteral melalui jejunostomi diberikan bertahap dan dilakukan penyesuaian berdasarkan toleransi enteral.
Hasil: Evaluasi menunjukkan adanya intoleransi enteral, ditandai dengan peningkatan drainase intraduodenal dan diare. Penyesuaian pemberian nutrisi dilakukan hingga toleransi enteral membaik. Namun, kondisi metabolik pasien memburuk hingga menyebabkan mortalitas.
Kesimpulan: Manajemen nutrisi jejunostomi pada lansia dengan perforasi duodenum menghadapi tantangan dalam mencapai toleransi enteral, meskipun telah dilakukan penyesuaian pada metode dan kecepatan pemberian. Intoleransi enteral dapat dipengaruhi oleh faktor usia lanjut, tingkat keparahan perforasi, dan komorbiditas, yang juga menjadi faktor mortalitas pasien. Penelitian lebih lanjut diperlukan untuk memberikan panduan berbasis bukti, mengenai manajemen nutrisi melalui jejunostomi pada pasien dengan perforasi duodenum.

 


Keywords


intoleransi nutrisi; jejunostomi; nutrisi enteral; pasien kritis; perforasi duodenum

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DOI: https://doi.org/10.22146/jkkk.104934

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