Long-Term Home Total Parenteral Nutrition During Pregnancy: A Case Report and Review of the Literature

Rationale: In a non-functioning gut during pregnancy, adapted
home parenteral nutrition can be used.
Methods: We present a patient prone to gastric bypass surgery
complications.
Results: A 31-year-old pregnant woman had recently undergone
a gastric bypass operation. She was unable to
tolerate food and liquids. She was dehydrated and in vitamin
depletion.
Abdominal ultrasound, confirmed by MRI, revealed superior
mesenteric vein thrombosis. Heparin treatment was initiated.
At 15 weeks of pregnancy, home total parenteral nutrition
(TPN) was initiated. Vitamins, trace elements and hydromineral
perfusions were added. Body weight increased (+9.4 kg
in three months). Monitoring of trace elements revealed an
increased copper level (201 mg/dl) after 4 weeks and a low
zinc value (64 mg/dl) at 11 weeks.
At 38 weeks, she gave birth to a healthy male child of 3.160 kg
with normal metabolic variables, plasma vitamin levels and
trace elements.
However, 5 weeks after cessation of intravenous feeding,
the patient developed severe abdominal pain. Explorative
laparoscopy confirmed internal small bowel herniation and a
360º twist of the alimentary loop of the bypass construction.
The intestinal loop was re-anastomosed and alimentary
passage facilitated. The patient regained normal oral food
intake.
Conclusion: Home parenteral nutrition, fluids, vitamins and
trace elements resulted in a healthy at term newborn without
fetal or maternal morbidity or mortality. The described
case underscores the importance of a problem-oriented
multimodality approach.