Caso clínico: propuesta de soporte nutricional en paciente crítico con fuga gastroesofágica, mediastinitis y choque séptico posterior a manga gástrica laparoscópica.

Abstract

Currently, bariatric surgery constitutes one of the most commonly performed surgical procedures for obesity. Although severe complications are relatively uncommon, there are reports of increasing morbidity and mortality associated with these procedures. Among the most common complications, gastroesophageal leakage represents one of the most serious due to its potential to progress to mediastinitis, sepsis, and multiple organ failure. Patients experiencing this type of postoperative complication develop a systemic inflammatory response that triggers a series of alterations in normal physiological function, including an increased energy expenditure secondary to protein catabolism. In addition, prolonged fasting resulting from the complexity of the clinical condition and the need for continuous complementary examinations and laboratory assessments to closely monitor the patient's clinical course may contribute to nutritional deterioration and increase the risk of refeeding syndrome when enteral nutritional support is initiated. This clinical scenario requires a carefully planned and meticulous approach by the clinical nutrition professional. The present clinical case aims to analyze the appropriateness of nutritional support in a patient with obesity who underwent laparoscopic sleeve gastrectomy complicated by a gastroesophageal leak, mediastinitis, and septic shock, through the application of the Nutrition Care Process and an analysis of scientific evidence and international nutritional guidelines.