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At least 307 records · Page 17Linked to original sources
PubMed2004

Strategies in managing chronic pancreatitis-placement of direct percutaneous endoscopic jejunostomy feeding tubes.

Patients with chronic pancreatitis (CP) often have maldigestion and malnutrition. Nutrition support during acute and CP traditionally has been provided by parenteral nutrition. In acute pancreatitis, jejunal feeding may accelerate resolution of the inflammatory process, protect against infection, and improve outcomes at a reduced cost when compared with parenteral nutrition. Jejunal feeding may also be beneficial for patients with CP. Prolonged jejunal access may be achieved via a direct percutaneous endoscopic jejunostomy (DPEJ). This article will review the rationale and evidence for jejunal feeding, indications and contraindictions for DPEJ placement, and the technique and outcomes of DPEJ in patients with CP.

Journal Article↗
PubMedDate not supplied

Bacterial contamination of continuously infused enteral alimentation with needle catheter jejunostomy--clinical implications.

The administration of elemental diet through fine needle catheter jejunostomy is becoming a common alternative route for postoperative feedings. The current review describes a septic syndrome which has been attributed to contamination of these feedings. The authors discuss a number of patient reports, as well as the etiology of the septic-like syndrome. Recommendations for the elimination of this syndrome are made and further review of patients during the course of changes in technique is described.

Aged↗
PubMedDate not supplied

Intraperitoneal infusion as a complication of needle catheter feeding jejunostomy.

The needle catheter feeding jejunostomy is being increasingly utilized for postoperative nutritional support. We report a case of catheter dislodgement with intraperitoneal infusion of an elemental diet with subsequent peritonitis and death. A review of the literature reveals this complication to occur in 1.5% of patients, even when the serosa of the small bowel has been attached to the anterior abdominal wall. Recommendations are made regarding the prevention and management of such complications.

Adenocarcinoma↗
PubMedDate not supplied

Perforation of the small bowel after insertion of feeding jejunostomy: a case report.

Feeding jejunostomy has become a useful method of feeding many patients with upper digestive tract dysfunction from a variety of causes. Although problems infrequently do occur with the tube itself, such as dislodgement or obstruction, most patients tolerate the procedure well. We report here a case of perforation of the jejunum that was caused by the tube itself and required reoperation. As with many problems in surgery, careful attention to technical details should help prevent this and other problems after feeding tube insertion.

Enteral Nutrition↗
PubMed1991

The Needle Catheter Jejunostomy: a useful and cost-effective adjunct in bariatric surgery.

The safety and efficacy of the needle catheter jejunostomy (NCJJ) is evaluated in 200 consecutive, prospectively studied gastric bypass procedure patients with a follow-up of 6 months to 9.5 years. The NCJJ was used in place of intravenous fluid administration from the first postoperative day to supplement oral fluids for 6 weeks postoperatively and for complete temporary supplementation in 16 patients with viral illness or pouch outlet obstruction, thus avoiding re-hospitalization for rehydration. We did not use X-ray confirmation of the catheter placement. Analysis revealed no major complications with no catheter dislodgment, associated intra-abdominal sepsis or late bowel obstruction. There were 24 (12%) subcutaneous infections, only four (2%) of which required minor incisions and drainage under local anesthesia. Risk factors for the infections were insulin-dependent diabetes mellitus and the actual withdrawal of the NCJJ (50% of the infections occurred at this time). The NCJJ has been a safe, useful and cost-effective adjunct in the operative management of the morbidly obese patient.

Journal Article↗
PubMed1988

Persistent jaundice after hepatic porto-jejunostomy in biliary atresia: are the patients' prognoses determined within 3 months after surgery?

Eighteen patients with biliary atresia who showed persistent jaundice after hepatic porto-jejunostomy were studied clinically. It was revealed that: 1) Patients who had abnormally high preoperative values of laboratory data showed persistent jaundice; 2) high portal pressure occurred frequently in patients with persistent jaundice; 3) most patients of persistent jaundice had a history of postoperative cholangitis; 4) in contrast to jaundice-free patients, those with persistent jaundice tended to show elevation in gamma-globulin, TTT and gamma-GTP in the early postoperative period. These results suggest that for patients showing an upward tendency in these laboratory data after surgery, carefully management should be taken, even if the serum bilirubin level continue to decrease.

Adolescent↗
PubMed1977

Bacterial flora of the small intestine and bile acid metabolism in patients with hepatico-jejunostomy Roux-en-Y.

Duodenal and jejunal bacterial flora and bile acid metabolism were investigated in 14 patients with hepatico-jejunostomy Roux-en-Y. Anaerobic culture procedures were based on the use of a glove-box with an oxygen-free atmosphere and pre-reduced, anaerobically sterilized media. Anaerobic transport was based on evacuation of atmospheric air from transport-tubes and transport-time less than 30 minutes. Bile acid metabolism was evaluated from concentrations of toal bile acids and deconjugated bile acids, glycine/taurine ratio and breath test. In 92 per cent of the patients an abnormal flora-containing anaerobic and/or aerobic bacteria was found in the most proximal part of the jejunum at the site of the entero-entero anastomosis (cf. Fig. 1 and Table 1). Total bile acid concentrations were low in half of the patients, whereas deconjugated bile acids or elevated glycine/taurine ratio was found in one patient only (cf. Table II). An abnormal breath test was found in 5 patients, but without any clear correlation between the breath test and the bacterial flora.

Adult↗
PubMed1978

[Jejunostomy for feeding purposes. Considerations on 100 cases].

Personal experience with 100 cases of jejunostomy for feeding purposes is reported. Stress is laid on the advantages of this feeding technique which include simple, surgical technique, easy administration of diet, speedy metabolic response and the moderate nature of the complications.

Adult↗
PubMedDate not supplied

Increased risk for gallstone disease in subjects operated on for partial gastrectomy with gastro-jejunostomy (BII operation).

The prevalence of cholelithiasis has been investigated in 301 male subjects (age range 35-60 years) operated on for partial gastrectomy with gastro-jejunostomy (BII), in 277 unoperated peptic ulcer patients (age range 30-60 years) and in a control population of 281 factory's workers (age range 31-58 years). The prevalence of gallstone disease resulted significantly higher in BII operated subjects (23.9%) than in unoperated (9%) and controls (8.5%). No difference was found between unoperated peptic ulcer patients and controls. These results indicate that BII operation is a high risk condition for cholelithiasis while peptic ulcer disease does not constitute a favourable factor for gallstone formation.

Adult↗
PubMed1989

[Early complications after hepatic porto-jejunostomy in biliary atresia].

Postoperative complications which developed within three years after hepatic porto-jejunostomy (Kasai's operation) in 126 patients of biliary atresia were analyzed. Ascending cholangitis developed in 47 of 97 bile excreted patients. The excretion of bile ceased in another 18 patients without any symptom of cholangitis. Adhesive ileus, bleeding from the porta hepatis, wound dehiscence, and anastomotic leak developed less frequently. The mortality rate of the patients with these complications, especially with cholangitis or with cessation of the bile excretion, was extremely high; twenty nine (62%) out of 47 patients with cholangitis, and 14(78%) out of 18 patients with cessation of the bile excretion died. On the other hand, the mortality rate in 24 patients with bile excretion but without any postoperative complication was only 8% (2 patients). An intussusception type antireflux valve in the Roux-en-Y loop was effective for preventing cholangitis; cholangitis developed in none of 8 patients with an anti-reflux valve, whereas cholangitis developed in 25(48%) of recent 52 patients without a valve.

Biliary Atresia↗
PubMed1983

Acute abdominal pain due to early postoperative elemental feeding by needle jejunostomy.

Early postlaparotomy needle jejunostomy feeding with an elemental diet resulted in a typical clinical entity in six of 160 patients (4 per cent). In all, an acute condition of the abdomen developed with a grossly distended intestine, filled with fluid and gas, and an empty stomach as confirmed roentgenographically or at a second laparotomy. This complication is presumably caused by carbohydrate hyperosmolarity of the elemental diet and carbon dioxide production by fermentation. The complication was seen predominantly in patients with a Roux-en-Y reconstructed pancreatectomy. In two patients, a negative second laparotomy was performed. In two others, a pancreaticojejunostomy suture line blowout followed, resulting in death. One patient died after aspiration of the gastric contents.

Abdomen↗
PubMed1983

Needle catheter jejunostomy (NCJ) for early postoperative feeding: experience in 210 patients.

Enteral feeding has many advantages over total parenteral nutrition (TPN) in the early postoperative period. The risk of sepsis is small, the nutrients are cheap and metabolic problems are rare. In the period April 1980 to January 1983, needle catheter jejunostomy (NCJ) was applied in 210 patients after surgery of the oesophagus, stomach, duodenum, liver or pancreas. All but 14 of these patients were fed by NCJ for a certain period postoperatively, NCJ feeding being initiated within 48 hours after the operation in 63% of the cases. In 14 patients, it was decided not to use NCJ feeding because of counter-indications observed postoperatively. The mean duration of the feeding by NCJ was 17 days (range two to 84 days). The complications observed were intraperitoneal leakage in four patients (1.9%), ileus in seven patients (3.3%) and diarrhoea in 54 patients (25.7%). The total number of feeding days was 2,906. This form of feeding resulted in savings of Dfl. 115,00 per patient per day compared with TPN, for a 12,600 Joule intake. NCJ feeding is a relatively safe, economical procedure that can be applied as a matter of routine after abdominal surgery.

Adolescent↗
PubMed1984

[The influence of obstructive jaundice on wound healing of pancreatico-jejunostomy with reference to the function of the pancreas as assessed by glucose tolerance and pancreozymin-secretin test].

Mongrel dogs jaundiced by ligation of the common bile duct for 3-week period were submitted to simultaneous biliary drainage and pancreatico-jejunostomy and sacrificed on day 1, 3, 5, 7, 14 and 30 after operation. The wound healing process of the anastomotic site was evaluated in terms of microvasculature, histopathological findings, pancreatic hydroxyproline content, incidence of anastomotic leakage and bursting strength of the anastomotic site. Pancreatic function were assessed by intravenous glucose tolerance and pancreozymin-secretin test. Acute inflammation at the anastomotic site was severer in the jaundiced pancreas on day 1, 3 and 5, respectively, than in sham operated controls. The group of dogs with serum bilirubin levels ranging 1 to 5mg/dl (mean 3.2) tolerated significantly higher bursting strength (p less than 0.01) with less incidence in anastomotic leakage (p less than 0.01) as compared to the group of dogs with serum bilirubin higher than 5mg/dl (mean 7.6). The data demonstrate that pancreatico-duodenectomy is primarily indicated to the icteric patients after serum bilirubin is decreased lower than 5mg/dl. Exocrine function of the pancreas showed no significant differences between the control and jaundiced dogs, but glucose tolerance in jaundiced dogs was decreased without appreciable changes in serum insulin levels.

Animals↗
PubMed1980

[A technique for continent feeding jejunostomy (author's transl)].

Nutrition is the main problem with inoperable gastroesophageal tumors. In 15 mongrel dogs the topmost jejunal loop was disconnected in a 'y' shape after Roux and diverted outwards, the small intestine anastomosed end-to-side. A sphincter plastic made of autologous small intestine muscles after the Würzburg method was wrapped as a sleeve around the thigh diverted to the epigastrium. The jejunostomy was absolutely continent; the dogs could be fed an elementary diet by means of a probe without their loss of weight or malaise. The mobility and the uncomplicated application signify improvement on the gastric fistula and parenteral feeding.

Animals↗
PubMed1981

Feeding jejunostomy under local anesthesia.

A feeding jejunostomy may be performed with ease and safety under local anesthesia. The authors describe their technique. The tube is easy to maintain and replace and avoids some of the problems of feeding gastrostomies. In patients with major nutritional problems and a functioning intestinal tract the need for parenteral nutrition may be eliminated.

Anesthesia, Local↗