A 55-year-old patient with known Crohn's disease presents with a high-output fistula (1200 mL/day) from the terminal ileum to skin after a previous ileocaecal resection. Nutritional assessment shows serum albumin of 2.4 g/dL. The surgical acronym SNAP describes the stepwise approach to complex fistula management. 'N' in SNAP stands for:
- A Nutrition (optimise nutritional status via TPN or enteral feeding) ✓
- B Nasogastric decompression
- C Neutralisation of sepsis
- D Nasointestinal tube placement
Correct answer: A. Nutrition (optimise nutritional status via TPN or enteral feeding)
Explanation
SNAP stands for: Sepsis control, Nutrition (optimise with TPN or enteral feeds), Anatomy (delineate fistula with imaging/contrast), and Procedure (definitive surgical repair after 4–6 weeks once nutrition is optimised and sepsis controlled). Nutritional optimisation — correcting hypoalbuminaemia and caloric deficit — is essential before any surgical repair.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.