{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:12:38Z","timestamp":1779196358868,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    This case report presented a unique, integrated nursing management strategy for a 47-year-old male with extreme complexity arising from radiation-induced enterovesical fistula and severe malnutrition-sarcopenia syndrome following irradiated rectal cancer surgery, addressing a critical literature gap in systematic protocols for high-mortality cases. It demonstrated the practical application and sequencing of advanced, refined interventions within a Damage Control Surgery (DCS) framework, offering a replicable model. Key admission findings included severe metabolic derangement (BMI 13.2\u202fkg\/m\n                    <jats:sup>2<\/jats:sup>\n                    , serum albumin 20\u202fg\/L, handgrip strength 12\u202fkg), uncontrolled intra-abdominal and gluteal abscesses with multidrug-resistant organisms, complex skin integrity issues (chronic sacrococcygeal pressure injury, incontinence-associated dermatitis), and anatomical complications (presacral abscess, small bowel dilation of 9.87 \u00d7 9.86\u202fcm, right ureteric obstruction). Primary diagnoses were radiation-induced multivisceral fistula, severe malnutrition-sarcopenia, and intra-abdominal infection. A phased, MDT-driven approach included: infection control via dual-catheter negative pressure irrigation; nutritional rehabilitation using a stepwise protocol from parenteral to enteral nutrition (short-peptide formula) guided by precise energy calculation and managed with a \u201cten-aspect\u201d strategy; advanced wound care combining recombinant human epidermal growth factor (rh-EGF) gel with silver ion dressings; and comprehensive functional rehabilitation through a personalized graded exercise prescription, including respiratory training via balloon blowing exercises enhanced by motivational tools (e.g., hanging inflated balloons bedside for engagement). Outcomes after 118\u202fdays showed substantial improvement: nutritional and metabolic recovery (weight increased from 38\u202fkg to 41\u202fkg, albumin rose to 35\u202fg\/L, electrolyte imbalances corrected); infection resolution (drainage cultures negative, abscesses resolved, bowel dilation reduced to 3.4 \u00d7 3.5\u202fcm); physical function restoration (handgrip strength improved from 12\u202fkg to 25\u202fkg, patient progressed from bedbound to ambulating 2\u202fh daily); and complete wound healing. The paramount lesson was that successful management required a systematic, phased, MDT-based nursing model integrating advanced technical interventions with meticulous, protocol-driven supportive care (e.g., structured nutrition and rehabilitation), proving critical for transforming prognosis in similar complex scenarios.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1750366","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:40:41Z","timestamp":1779194441000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nursing care for a patient with multiple organ fistulas and severe malnutrition-sarcopenia syndrome following surgery for irradiated rectal cancer: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Changdi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Oncology Surgery, Nanjing Jiangning Hospital","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Surgery, Nanjing Medical University Kangda College Jiangning School of Clinical Medicine","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ai","family":"Li","sequence":"additional","affiliation":[{"name":"Nursing Department, Nanjing Jiangning Hospital","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xing","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology Surgery, Nanjing Jiangning Hospital","place":["Nanjing, Jiangsu, China"]},{"name":"Chinese Hospital Reform and Development Institute, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.19538\/j.cjps.issn1005-2208.2025.03.08","article-title":"Treatment principles and strategies for radiation intestinal injury complicated with intestinal fistula","volume":"45","author":"Qiyuan","year":"2025","journal-title":"Chin J Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e512","DOI":"10.1016\/j.ijrobp.2023.06.1771","article-title":"Efficacy and safety of local radiotherapy combined with chemotherapy \u00b1 bevacizumab in the treatment of patients with advanced and recurrent 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