Stepwise Multimodal Medical Nutrition Therapy, 1:1:1 Supplemental Parenteral Bridging, and Early Oligomeric Oral Supplementation in Locally Advanced cT4bN1bMx Rectal Adenocarcinoma Post-Diverting Colostomy: A Case Report

Background: Locally advanced rectal adenocarcinoma (cT4bN1bMx) with distal bowel obstruction causes systemic inflammation, anorexia, and postoperative catabolism after diverting colostomy, while normal body mass index (BMI) and albumin can mask malnutrition risk. Objective: To describe the stepwise nutrition prescription from the day of colostomy (T₀) to postoperative day 3 (T₃) against ESPEN reference intervals. Methods: This single-patient case report (CARE guideline) describes a 71-year-old woman (62.0 kg, 158.0 cm, BMI 24.84 kg/m², blood pressure 144/65 mmHg, leukocytes 14.97 × 10³/μL, albumin 4.0 g/dL) with a 2.7 cm cT4bN1bMx rectal adenocarcinoma invading the uterine fundus and small bowel. Intake was compared with ESPEN intervals (1,550–1,860 kcal/day; > 62.0–93.0 g/day protein). Results: After diverting colostomy (T₀), clear liquids on postoperative day 1 (T₁; 450 kcal/day, 0.0 g protein) were bridged with 1:1:1 supplemental parenteral nutrition (5% dextrose : 10% Kalbamin : 20% SMOFlipid; 650 kcal/day, 25.0 g amino acids; total 1,100 kcal/day; non-protein calorie-to-nitrogen [NPC:N] ratio 250.00:1). The prescription advanced through T₂ (1,450 kcal/day, 60.0 g protein; NPC:N 126.04:1) to the full target on postoperative day 3 (T₃: 1,800 kcal/day [29.03 kcal/kg/day] and 80.0 g/day protein [1.29 g/kg/day; 12.80 g N/day; NPC:N 115.63:1]) with a soft diet plus 2 × 200 kcal/day oligomeric oral nutritional supplements (oral energy +300.00%, total energy +63.64%, protein +220.00%). No adverse events were recorded. Conclusion: A stepwise parenteral-to-oligomeric oral transition reached the prescribed energy and protein targets within 72 hours after colostomy. GLIM, sarcopenia, stoma-output, and refeeding-electrolyte surveillance is advisable; one case cannot establish causality.