Background: SMAS is an upper gastrointestinal obstruction associated with compression of the duodenum between the abdominal aorta and the SMA. SMAS occur in high catabolic states and neurological injury resulting in spasticity, including cerebral palsy.
Client History: A 10 year-old Kelantanese Malay girl with spastic quadriplegia CP was admitted into HUSM, presented with abdominal distension and greenish vomitus, then diagnosed with SMAS.
Assessment: Patient’s body weight was 13kg (10th-25th percentile of CP growth charts, stratified according to GMFCS level) with estimated height 104.9cm (25th percentile). Estimated energy requirement was 1200kcals. She was planned with Total parenteral nutrition (TPN) 800kcals/day and allowed orally during the first visit. She only achieved minimal energy requirement due to very poor appetite.
Nutrition Diagnosis: Inadequate energy intake (NI-1.2) related to poor appetite associated with stomach distention as evidenced by patient’s energy intake (41.3%).
Dietary prescription: To improve nutritional intake and prevent further nutritional deterioration, 1000kcals was aimed from oral nutrition support (ONS) and 200kcals from hospital blenderized diet. High concentration feeding (1.3kcal/ml) was also challenged due to volume restriction of 500-700ml/day.
Outcomes: During three subsequent follow ups, patient’s oral intake fluctuated due to poor oral health condition (ranula) and TPN continued. High concentration feeding was changed (0.9kcal/ml) due to patient’s intolerance. She gained 1kg in 2 weeks. Patient was discharged with Ryle’s tube due to persistent poor oral intake.
Discussions: Successful conservative treatment includes electrolyte imbalance correction, appropriate nutrition support and left lateral decubitus position may reduce the needs for surgical intervention of SMAS.
Summary: A well-planned nutrition case management according to patient’s condition is very important to improve clinical outcome.
Disclosure Statement: Nutrition and Dietetics Department of HUSM.
Learning Points:
• The role of nutrition care in conservative management of SMAS.
• Variable nature of CP needs comprehensive nutritional assessment according to needs and condition.
• Optimization of dietary intake through intensive nutritional support
