PubMed · 10446850
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T O Lipman. 1999. Possible duplicate publication.. https://doi.org/10.1097/00003246-199907000-00052
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Small bowel necrosis is a rare but highly lethal complication associated with postoperative jejunal tube feeding. The causative mechanism remains unclear but is most likely the result of several factors. The ischemic necrosis was preceded by progressive abdominal pain, distension, hypotension and hypovolemia. Timely recognition and surgical intervention may save the patient's life. Percutaneous enteral tube feeding may be used with utmost caution.
The provision of enteral nutrition through the placement of gastrostomy/gastrojejunostomy tubes is a well-established procedure. Traditionally, these catheters have been placed either surgically or endoscopically; however, over the past two decades interventional radiologists have increasingly performed these procedures successfully. The perceived advantages of this route lie in the reported lower morbidity and mortality rates. In addition, percutaneous radiologically guided (PRG) catheters may be placed in certain subgroups of patients in whom it would be technically difficult or impossible by other routes, e.g., patients with head and neck or oesophageal tumours. The aim of this review is to describe the techniques of radiologically placed gastrostomy/gastrojejunostomy, discuss its indications and contraindications, describe any associated potential complications and compare PRG results with the more established techniques of open surgical and endoscopic placement. We also describe some recent procedural and catheter modifications.
BACKGROUND: Preexisting malnutrition has been shown to be a major clinical problem in surgical patients. Surgical stress itself increases the energy expenditure and protein loss making necessary the early nutritional support. Although there is strong evidence that "nil by mouth" is not justified, the data are still conflicting over the role of early enteral nutrition compared with the traditional methods of postoperative feeding including total parenteral nutrition support. METHODS AND FOCUS: This paper deals with the various trials related to early enteral feeding. It also compares this with the possible advantages of total parenteral nutrition as a method of perioperative nutritional support in patients undergoing gastrointestinal surgery.