title: Preoperative assessment in cases of adult megacolon suffering from moderate malnutrition.
abstract: Acquired megacolon is a chronic disease associated with constipation and malnutrition. Surgical treatment may be required for the alleviation of the intestinal symptoms, emphasizing the interest of nutritional assessment in this population. In a prospective study of 33 patients suffering from acquired megacolon and requiring either anterior resection or pull-through operation, standard anthropometric and biochemical measurements as well as the PNI of Buzby and Mullen were preoperatively assessed. Mean age of the population was 49 +/- 13 y, with 17 males and 16 females. The combined nutritional score indicated 63.6% of the population were malnourished (21/33) of the patients, whereas the Prognostic nutritional index (PNI) revealed 3 high-risk cases (9.1%), 9 with moderate risk (27.3%), and reduced risk for all others. Indeed, 39.4% (13/33) of the patients displayed surgical or septic problems. Chi-square analysis confirmed that both studied criteria were significantly associated with complications (p < 0.05), as morbidity was restricted predominantly to cases with unfavorable Prognostic nutritional index (PNI) results or clear signs of nutritional deficit. Both PNI and conventinoal nutritional assessment are valuable tools for the screening of these surgical candidates. Artificial alimentation was not used in this experience, but deserves consideration in selected patients. Nutritional status improved in the late postoperative period, with normalization of bowel function.
authors.affiliation: Division of Gastrointestinal Surgery, Hospital das Clínicas, São Paulo, Brazil.
authors.forename: M J
authors.initials: MJ
authors.lastname: Vieira
authors.forename: J J
authors.initials: JJ
authors.lastname: Gama-Rodrigues
authors.forename: A
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: J
authors.initials: J
authors.lastname: Faintuch
authors.forename: D L
authors.initials: DL
authors.lastname: Waitzberg
authors.forename: H W
authors.initials: HW
authors.lastname: Pinotti
mesh_terms: D000328:Adult; D014355:Chagas Disease; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008531:Megacolon / Q000150:complications* / Q000469:parasitology / Q000601:surgery*; D008875:Middle Aged; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires