Use of an Oral Nutritional Supplement Containing Calcium Beta-Hydroxy-Beta-Methylbutyrate (CaHMB), L-arginine, and L-glutamine May Have Helped Avoid Surgery That Could Have Led to Short Bowel Syndrome: A Case Report.

We present a case in which conservative therapy with oral nutritional supplements (ONS) containing calcium beta-hydroxy-beta-methylbutyrate (CaHMB), L-arginine (Arg), and L-glutamine (Glu) was performed for postoperative small intestine-incision site fistula due to suture failure following surgery for intestinal obstruction after a cesarean section and avoided surgery that carried a high risk of short bowel syndrome in short small intestine patient due to multiple surgeries for Crohn's disease. We report the case of a 39-year-old woman patient. She was diagnosed with Crohn's disease at 14 years old and has undergone multiple surgeries in the past. Jejunostomy was created in the remaining 150 cm of her small intestine. Cesarean section was performed due to preterm labor, but subsequently, the patient developed adhesive small bowel obstruction that was resistant to conservative treatment, and an open abdominal operation was performed. During the surgery, two extensive small intestine injuries were identified, but due to concerns about short bowel syndrome resulting from resection, suture reinforcement was performed. However, an intestine-wound fistula developed due to suture failure in the same area. Since the patient wished for conservative treatment, intestinal fluid was continuously aspirated while using a combination drink containing CaHMB, Arg, and Glu (Abound™, Abbott Japan LLC, Tokyo, Japan). After taking Abound™, there was a marked increase in granulation tissue and narrowing of the fistula. Intestinal fluid discharge stopped 13 days after taking Abound™, and the patient began eating on the 16th day. The patient was discharged on the 22nd day, and the wound healed on the 36th day.