Distal Bowel Re-feeding in Patients with Proximal Jejunostomy

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Anand NagarSamiran Nundy

Abstract

Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure. There were 26 males and 9 females, whose median age was 47 (19-74) years. The most common indications for massive bowel resection were gangrene in 25 (71%) and intestinal perforation in 7 (20%). The median proximal and distal small bowel lengths were 45 (15-120) cm and 90 (0-240) cm respectively. The ileocaecal (IC) valve was preserved in 33 (94%) and there was only colon distally (without the ileocaecal valve) in 2 (6%) patients. Twenty-five (71%) patients required post-operative ICU care. Additional PN was required in 6 (17%) patients during their index admission with the average extra cost of treatment being 20,000 rupees. Their median hospital stay was 13 (6-60) days. Patients were discharged without intravenous (IV) lines. Eight (26%...Continue Reading

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Citations

Sep 25, 2019·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Sameer BhatGreg O'Grady
Apr 19, 2020·The British Journal of Surgery·P SharmaG O'Grady
Aug 22, 2020·The British Journal of Surgery·Uday Somashekar, Dhananjaya Sharma
Apr 26, 2020·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Sabrina LayecDenis Picot

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