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At least 271 records · Page 15Linked to original sources
PubMed1991

Jejunostomy feeding for the conservative management of spontaneous rupture of the oesophagus.

Three patients with spontaneous rupture of the oesophagus (Boerhaave's syndrome) were successfully treated by a conservative regimen consisting of nil orally and broad-spectrum antibiotics, while their nutrition was satisfactorily maintained by jejunostomy feeding. Such a regimen is simpler and cheaper than one utilising parenteral nutrition: it avoids its complications and limitations, and will enable healing to take place within three weeks after the rupture has occurred. It is therefore suggested that the conservative management of Boerhaave's syndrome is the treatment of choice.

Adult↗
PubMed1990

[A lingulate valve formed from full layer of the jejunum in Roux-en-Y choledocho-jejunostomy and its effect against regurgitation of intestinal contents].

A lingulal valve formed from full layer of the jejunum designed to work against regurgitation of intestinal contents was reported. Animal experiment and the observation on fresh bodies documented that it could prevent regurgitation at the pressure of 2.94 kPa (300 mmH2O). The valve-plasty was added to Roux-en-Y choledocho (pancreatico)-jejunostomy in ten cases with satisfactory results. The procedure is not technically difficult, and long term follow-up found no severe complications.

Adult↗
PubMed1989

[Colonic lesion caused by acute pancreatitis. Use of minimal catheter jejunostomy. Apropos of 6 cases].

Colonic affectation in the context of acute pancreatitis is undoubtedly a rare complication to judge from the number of cases reported in the literature, but its appearance is increasing, perhaps because it is receiving more attention. The "infrequent" complications of so-called acute pancreatitis range from massive necrosis of the colon to fistula of the transverse colon, colonic stricture as a chronic manifestation and finally, colonic varices as a sign of segmental portal hypertension due to involvement of the mesenteric portal axis. A retrospective study was made of 6 cases treated in our General and Digestive Surgery Department and the literature on this etiopathogenic situation was reviewed to study the clinical manifestations, diagnosis and treatment of these uncommon complications. We propose minimal catheter jejunostomy as a technique for the prevention and treatment of possible complications, with epidural analgesia of these patients.

Acute Disease↗
PubMed1989

[Complete section of the choledochus caused by non-penetrating trauma of the abdomen. Use of minimal catheter jejunostomy].

A case is presented of complete section of the choledochus as the sole lesion in closed abdominal trauma. A study is made of the difficulties of an early diagnosis of this pathology, as well as techniques for intraoperative localization and repair. Emphasis is placed on the use of peritoneal lavage as a preoperative diagnostic method and Tc99m HIDA scintigraphy of the biliary tract. The surgical technique is reviewed, assuming that the most physiological and anatomic procedure is end-to-end choledochoduodenostomy using reabsorbable sutures. We recommend the use of minimal transcatheter jejunostomy (YMC) as a method for immediate replacement of bile juice and inhibition of secretion, as well as the possibility of postoperative physiological nutrition using this approach.

Adult↗
PubMed1987

Percutaneous conversion of surgical gastrostomy to jejunostomy: indications and technique.

Should a surgical gastrostomy prove to be inappropriate it can readily be converted to a jejunostomy using standard percutaneous techniques. We have used this technique in six patients with gastro-esophageal reflux, four with gastric perforation, two with gastric outlet obstruction, two with duodenal perforations, and two patients with gastrostomy breakdown. Technical success was achieved in all and clinical success in 15 of 16.

Adult↗
PubMedDate not supplied

[The bioavailability of drugs administered via a minimal jejunostomy catheter. A clinico-experimental study].

For the evaluation of the bioavailability of drugs administered through a minimal jejunostomy catheter (MJC) postoperatively, ampicillin and metronidazol were administered via this route. The study with ampicillin consisted of a first cross-over experimental trial, in which six dogs were used, and a second based on the experience with four human volunteers. As a measure of the absorption of the drug, the serum levels of the lower plasma area are monitored. The statistical analysis was done by means of logarithmic transformation of the areas, and two-way analysis of variance. The posterior distribution of the relative bioavailability of the drug was obtained by applying a bayesian method. The results showed an important decrease of the ampicillin absorption, while the expected bioavailability when administered through MJC was 0.24, and the 95% interval (0.19, 0.30). The expected bioavailability of metronidazol when administered through MJC was 0.84, and the 95% interval (0.66, 1.07). This new route of drug administration in patients who undergo abdominal surgery, is shown to be of great importance from a clinical point of view, and should be kept in mind.

Adult↗
PubMed1995

Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: a population-based study.

OBJECTIVE: To determine the indications for use of surgical gastrostomy (SG) and surgical jejunostomy (SJ) as feeding tubes, the complications, and the trends in the use of SG and SJ after the introduction of percutaneous endoscopic gastrostomy (PEG) at our institution in 1981. DESIGN: We conducted a retrospective, population-based cohort study of residents of Olmsted County, Minnesota, who received surgically placed feeding tubes between 1976 and 1989. MATERIAL AND METHODS: The medical records of all Olmsted County residents with surgical placement of a feeding tube during the designated study period were reviewed, and underlying conditions, complications, and survival were analyzed. RESULTS: Of 77 adult patients (mean age, 66 years; 48% women), 54 underwent SG and 23 had SJ. General anesthesia was used in 42 patients (55%). The indications for SG or SJ were stroke in 23 patients, cancer in 19, other central nervous system-related conditions in 16, and other conditions in 19. Among the numerous comorbid conditions, pulmonary disease (N = 44) and cardiac disease (N = 32) were most frequent. The median duration of follow-up was 181 days. Complications occurred in 31 of 54 patients (57%) with SG and in 13 of 23 (57%) with SJ. Of the 117 complications, 15% were considered major. Twenty patients (26%) resumed eating. Survival at 1, 6, and 12 months was 79%, 49% and 36%, respectively. Most deaths were due to the disease for which the feeding tube had been placed. In a Cox proportional hazards regression analysis, only age and hypoxemia were found to be significantly associated with survival. Hypoxemia, type of tube, central nervous system disease as indication for procedure, and previous aspiration were associated with failure to resume eating (P < 0.05). Survival was similar to that for our patients with PEG during the same period. The overall incidence of feeding tube placement increased throughout the study period. CONCLUSION: Patients who require enteral feeding tubes have multiple comorbid conditions that have a major influence on the outcome. The overall incidence of feeding tube placement increased after the introduction of PEG. In patients who require long-term enteral nutrition and are unable to have a feeding tube placed percutaneously, surgically placed feeding tubes have outcomes similar to those reported for patients with PEG.

Aged↗
PubMed1994

Laparoscopic gastrostomy and jejunostomy: review of 22 cases.

Laparoscopic gastrostomy (LG) and laparoscopic jejunostomy (LJ) were performed successfully on 22 consecutive patients after development of the procedure on a porcine model. Patients did not undergo percutaneous endoscopic gastrostomies (PEG) due to obstruction from head and neck, esophageal cancer, gastropexy for gastric volvulus, perforated esophagus, failed PEGs, or surgeon's preference. Operative time averaged < 20.5 min. Five patients underwent the procedure under local anesthesia with intravenous sedation and three patients were operated on in a strictly outpatient setting. There was one postoperative death. LG and LJ are safe alternatives to open enterostomy in patients who cannot undergo PEG.

Adult↗
PubMed1996

Analysis of complications and long-term outcome of trauma patients with needle catheter jejunostomy.

Enteral feedings demonstrably lower the risk of septic complications. However, complications associated with the specific method of enteral feeding may diminish the intended benefits. The objective was to determine the short and long-term complications associated with needle catheter jejunostomy (NCJ). All NCJs placed at a Level I trauma center over an 8-year period were reviewed. Short-term complications directly attributable to NCJ were defined as tube leakage with intraabdominal or intraparietal spillage, intraabdominal abscess, small bowel obstruction at the catheter site, tube blockage or dislodgement, or soft tissue infection. Telephone interviews were conducted to elicit long-term complications, including operations to correct a complication of the NCJ, chronic nausea, vomiting, diarrhea, bloating, hernia, or change in appetite. Of 122 study patients, short-term complications (N = 22) included two abscesses, one bowel obstruction, two abdominal wall infections, three leaks, one local soft tissue infection, one enterocutaneous fistula, three blocked catheters, and nine tube dislodgements. Fifty patients were contacted by telephone; 19 had long-term complications, including two operations for adhesions. Complications associated with NCJ are common, may be life-threatening, and may require surgical intervention. In many cases, other methods of enteral feeding access may be preferable to NCJ.

Abdominal Abscess↗
PubMed1996

Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review.

OBJECTIVES: Severe diabetic gastroparesis leading to recurrent episodes of diabetic ketoacidosis and frequent hospitalizations can be among the most disabling of all diabetic complications. Surgical placement of a jejunostomy tube (J-tube) beyond the affected stomach to deliver fluid, nutrients, and medication is one of the few therapeutic options remaining in the cohort of patients who have failed standard medical therapy. This study attempts to define the natural history of refractory diabetic gastroparesis and the risks and benefits of J-tube placement. METHODS: A total of 26 patients with diabetic gastroparesis requiring J-tube placement were identified between 1980 and 1994. Medical chart review and telephone follow-up were performed using standardized questionnaires. RESULTS: All patients had documented delayed gastric emptying, had failed medical therapy, and had been hospitalized on multiple occasions. Neuropathy, retinopathy, and nephropathy were observed in 88%, 81%, and 65% of patients, respectively. The mean duration of study follow-up was 47 months (1-130 months). The mean age of subjects at the time of J-tube placement was 31 yr, and a preponderance of female patients (73%) was noted. There were 23 major complications in 14 patients requiring surgery or hospitalization and 47 minor complications in 21 patients managed on an outpatient basis. The mean duration of J-tube use was 20 months. There were 10 deaths during follow-up, one related to J-tube placement. Retrospectively, 39% reported improved symptoms of nausea/vomiting (4% worsened), 52% reported fewer hospitalizations (4%, more frequent), 56% reported improved nutritional status (4% worsened), and 83% reported improved overall health (4% worsened) after J-tube placement. The improvement in overall health status was the only symptom that reached statistical significance. CONCLUSION: Severe refractory gastroparesis is associated with multiple hospitalizations, a high incidence of concomitant diabetic complications, and a mortality rate of 38% at 4 yr. There is a high incidence of complications following J-tube placement in this population. Despite this, most patients retrospectively reported improved overall health after J-tube placement. Therefore, placement of a J-tube may be a workable option with acceptable perioperative morbidity and mortality rates in selected patients with severe diabetic gastroparesis who have failed medical therapy. A prospective study of J-tube placement and other available means of nutritional support is needed to demonstrate further the efficacy of this intervention in patients with severe diabetic gastroparesis.

Adult↗
PubMed1995

[Enteral nutrition in patients with ileostomies and jejunostomies].

Jejuno- and ileostomy are common surgical procedures. Due to shortening of effective bowel length intestinal failure, or short bowel syndrome develops. Degree of intestinal failure depends upon 1. resection length, 2. resection location, 3. function of the bowel remnant, stomach, pancreas and liver, 4. adaptive capabilities of the bowel remnant and 5. the disease that was cause of the surgery. In majority of these patients adequate nutrition can be achieved using enteral nutrition. Water and mineral absorption differs between jejunum and ileum. Jejunal mucosa is permeable to sodium and water, causing jejunal content to be isoosmolar to plasma. When sodium concentration in jejunal content is less than 90 mmol/l secretion of sodium into the lumen occurs. Ileal sodium absorption takes place against concentration gradient. Potassium concentration of jejuno- and ileostomy effluent is fairly constant at about 15 mmol/l. Main therapeutic problem is water and mineral loss. In jejunostomy patients hyponatremia is a major concern. Urinary sodium concentration of less than 5 mmol/l is a sign of sodium deficiency. This group of patients should have daily urinary output of more than 800 ml, and urinary sodium concentration of more than 20 mmol/l. Another important problem is malnutrition. Weight changes, albumin and trasferin are important follow-up parameters. Often neglected problem is large stomal effluent volume, that can incapacitate patient for the usual life. All these problems can be prevented by the adequate nutritional support. Oral' fluids should have minimal sodium concentration of 90 mmol/l. Intake of sodium poor fluids should be restricted. If plasma or urinary sodium are low intravenous sodium supplementation is warranted. Magnesium and zinc should be monitored and supplemented. Addition of vitamin D can improve their absorption. Vitamins B12 and K must be given parenteral, because their resorption is severely impaired. Patient should eat usual food rich in carbohydrates and proteins, but exact menu must be individualized, and reached by trial and error process. Fat absorption is proportional to fat intake. Fat does not increase stomal effluent, therefore there is no reason to restrict intake. In order to reduce stomal effluent volume and bowel motility H2 blockers, proton pump inhibitors and antidiarrhoeal drugs (codeine or loperamide) should be used.

Enteral Nutrition↗
PubMed1998

[Technique of laparoscopic pancreatocysto-jejunostomy].

Usually the development of a pancreatic pseudocyst in the course of pancreatitis is followed by surgical intervention. In case of operation an internal drainage is preferred to an external according to general experience. We have developed a simplified technique of pancreatocysto-jejunostomy without Braun- or Roux-Y-anastomosis. Here we present our surgical strategy in the laparoscopic technique.

Anastomosis, Surgical↗
PubMed1998

Direct percutaneous endoscopic jejunostomy.

Jejunal feeding often is preferable to gastric feeding, particularly in the following situations: high risk for aspiration; gastric resection (partial or total); gastric pull-up; gastric outlet obstruction; obstructed or nonfunctioning gastrojejunostomy; and gastric dysmotility. The technique of placing a thin tube through a gastrostomy tube and pulling it endoscopically into the proximal jejunum allows delivery of nutrients into the jejunum. The results of this technique, however, have been poor. The direct percutaneous endoscopic jejunostomy technique allows placement of tubes directly in the jejunum with a success rate of around 85% and a minimal complication rate which is comparable to that of PEGs.

Endoscopy, Gastrointestinal↗
PubMed1998

Pediatric percutaneous endoscopic jejunostomy by J-tube extension through a preexisting gastrostomy site: a preliminary report.

A prematurely born 5-year-old boy with chronic lung disease, hypoxic-ischemic encephalopathy, cerebral palsy, repeated aspiration pneumonia, and stroke underwent percutaneous endoscopic jejunostomy (PEJ) to alleviate repeated aspiration pneumonia. Studies, including 24-hour esophageal pH monitoring, 99mTc gastric emptying time, upper gastroesophageal barium radiography, and endoscopic examinations showed severe gastroesophageal reflux and prolonged gastric emptying. Percutaneous endoscopic gastrostomy (PEG) was performed first, followed by placement of a polyurethane J-tube (9 French) through the preexisting gastrostomy site. We passed the style-guided J-tube through the pyloric ring endoscopically and advanced it to the jejunum. The position of the J-tube was confirmed by radiologic study. Feeding with an elemental formula, 20 mL/hour, commenced immediately after the procedure, and the rate was gradually increased to 50 mL/hour. No further episodes of aspiration pneumonia have occurred since J-tube placement. Our initial experience with jejunal feeding through a PEJ is encouraging.

Child, Preschool↗
PubMed1998

[Enteral feeding of problem patients: replacement of surgical catheter jejunostomy by an endoscopic concept].

Percutaneous endoscopic gastrostomy (PEG), is widely used as a safe, effective method of providing enteral nutrition to patients in whom oral feeding is not possible. However, in patients with malnutrition after partial or total gastrectomy, anastomotic insufficiency after gastric resection or esophageal resection with gastric pull-up, esophageal perforation and fistulas, the stomach cannot be punctured. In these cases endoscopic percutaneous jejunostomy (EPJ) by direct punction of the small intestine is a reasonable alternative; the technique is described, and the results of a series of 103 EPJs are reported.

Adolescent↗