[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The perioperative nutrition status is an important factor that affects the patient outcome. However, there are few reports on the current situation of postoperative nutrition management. Although there is new evidence supporting the significance of the serum albumin level and perioperative albumin metabolism, most surgeons may not be aware of their importance. Thus, we conducted a WEB survey for surgeons asking about their current awareness of perioperative albumin kinetics and the current situation of postoperative nutrition management. As a result, there were many surgeons who were not aware of the significance of serum albumin levels and albumin metabolism. Regarding postoperative nutrition management, there were many cases in which the amounts of energy and protein administered were insufficient, and they were not administered in accordance with the current clinical guidelines. In particular, there were many surgeons who did not pay attention to the amount of protein administered. Our survey revealed the low awareness of albumin by surgeons and the current situation of postoperative nutrition management. The dissemination of accurate knowledge and appropriate nutrition management must be promoted.

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 A 71‐year‐old female with type II diabetes mellitus presented with back pain. Abdominal CT and MRI revealed unresectable pancreatic tail cancer and a metastatic hepatic tumor. First‐line chemotherapy was started, but progressive disease（PD）of the metastatic hepatic tumor was noted after 8 months. Second‐line chemotherapy was then started, but she was diagnosed with PD of the primary tumor after 3 months. At 1 year and 2 months after the initial diagnosis, she presented with abdominal pain. We performed transverse colostomy and loop enterostomy as emergency surgery under a diagnosis of ileus due to direct invasion by pancreatic tail cancer. On postoperative day 0（0 POD）after the operation, she developed septic shock, disseminated intravascular coagulation（DIC）and hyperosmolar hyperglycemic syndrome（HHS）．The administration of thrombomodulin alfa, bolus dose of saline and continuous intravenous injection of insulin resolved septic shock and DIC on 7 POD, and HHS on 14 POD. We report a case of unresectable pancreatic tail cancer with HHS due to ileus and direct invasion, with a review of the literature.

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