Postoperative enteral hyperalimentation for cryptosporidial acute cholecystitis associated with AIDS and enteritis

A homosexual youth presented with undiagnosed acute cryptosporidial cholecystitis, a fever of 102.8 degrees F and a WBC of 3500/mm3. This was preceded by several months of watery diarrhea and 20% weight loss. Following cholecystectomy, G-I function was maintained by efficient esophageal aspiration of swallowed air, with simultaneous immediate duodenal feeding of elemental diet. He absorbed 160 g amino acids and 4200 kcal, and was safely self-sufficient when discharged 26 hours postoperatively. Reappearance of the persistent cryptosporidial enteritis was followed by diagnoses of the offending organism and the associated AIDS. He failed to respond to specific spiramycin therapy, and 8 months after cholecystectomy he succumbed to pneumocystis carinii pneumonia. For this malnourished and particularly vulnerable patient, preservation of postoperative G-I function and its exploitation for enteral support may have been essential to enhance "immune competence" and lead to a remarkably smooth and rapid recovery.