SEARCH · Search PubMed

Results for “Jejunostomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

Subcutaneous jejunostomy.

When the surgeon must obviate to an impending obstruction because of an unresectable tumor of the supramesocolic space and an intestinal bypass is not feasible, a jejunostomy is usually indicated. We describe a new method to provide enteral nutrition via a subcutaneous jejunostomy without any external device, which can be used only when the patient is at risk for developing an obstruction or dysphagia. The feeding tube is inserted into the jejunum and then connected to a Port-a-Cath lodged in a subcutaneous pocket. Subsequently, the nutrition can be delivered via a Huber needle inserted in the port, or, to minimize the need for strict aseptic surveillance, the tube can be exteriorized from the pocket and used as the usual tube jejunostomy. This procedure allows placing a precautionary jejunostomy without distortion of the body-image.

Enteral Nutrition↗

PubMedDate not supplied

Limitations of percutaneous endoscopic jejunostomy.

Thirty-six patients at the University of Kentucky Medical Center underwent percutaneous endoscopic jejunostomy placement between January 1 and December 31, 1989. We retrospectively reviewed their charts for indications and complications of the procedure. Experience and outcome with the initial placement of the percutaneous jejunostomy tube was evaluated. Primary diagnoses at the time of insertion included central nervous system disorders (28), ventilator dependence (5), cancer (2), and gastroparesis (1). The follow-up period ranged from 2 to 131 days (median 16 days). Tube dysfunction or dislodgment occurred in 31% of patients. Other complications included pulmonary aspiration (11%) and bleeding at the insertion site (3%). The 30-day mortality rate was 19% with all but one death caused by the severity of the underlying primary illness. It is concluded that problems with the currently performed technique of percutaneous endoscopic jejunostomy, along with tube-related problems, seriously limit the usefulness of this technique. Improvements in technology, along with routine postprocedure radiographs to allow early detection of malpositioned jejunostomy tubes, may improve the outcome of this procedure. Newer techniques that have a higher success of distal small intestinal placement need to be evaluated.

Adolescent↗

PubMedDate not supplied

Transverse Witzel-T-tube feeding jejunostomy.

BACKGROUND: In patients prone to recurrent aspiration, a feeding jejunostomy is only performed to ensure adequate nutrition. A popular method for placement of the jejunostomy tube is the Witzel procedure, employing a sersosal tunnel on the antimesenteric border. The Witzel procedure, however, frequently suffers from the complication of tube dislodgement and obstruction due to narrowing of the intestinal lumen. METHODS: To minimize the complications associated with the standard Witzel method, we modified the procedure wherein a T-tube is substituted for a standard French rubber catheter, and transversely sutured to the mesenteric border. We believe that the placement of the Witzel line in the transverse plane minimizes the risk of obstruction, and substitution of a T-tube for a standard French catheter should reduce the incidence of tube dislodgement. RESULTS: The Transverse Witzel T-tube feeding jejunostomy has been performed successfully in 30 patients without any complications of tube dislodgement or leaks, and no tube to date has been difficult to remove. Length of tube use has ranged from 1 to 6 months, and no postoperative complications have been observed in this group. CONCLUSIONS: The Transverse Witzel T-tube jejunostomy is an effective and rapid technique for placement of a feeding tube. No serious complications have been observed, and the complication of tube dislodgement appears to be decreased compared to the standard Witzel procedure.

Enteral Nutrition↗

PubMed2005

[Clinical experience of percutaneous endoscopic gastrostomy, jejunostomy, duodenostomy in 120 patients].

OBJECTIVE: To report clinical experience of percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy in 120 patients, focusing on its technique and indications. METHODS: One hundred and twenty patients received percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy from May 2001 to April 2004, including 75 percutaneous endoscopic gastrostomy (PEG), 42 percutaneous endoscopic jejunostomy (PEJ), 2 percutaneous endoscopic duodenostomy (PED), 1 direct percutaneous endoscopic jejunostomy (DPEJ). All tubes established by traditional pull technique. RESULTS: The average duration of PEG was (9 +/- 4) min, PEJ (17 +/- 6) min, DPEJ 20 min, and PED was 10 and 12 min for 2 patients, respectively. Success rate of the technique was 98.4% (120/122). Major complication rate was 0.8% (1/120), and minor complication rate was 7.5% (9/120). Clinical indications: PEG, PED and PEJ were applied for long-term enteral nutritional support in 88 patients, gastrointestinal decompression in 25 patients, and transfusing external drainage bile to gastrointestinal tract in 5 patients. Two radiation enteritis patients used PEG for gastrointestinal decompression preoperatively and long-term enteral nutritional support postoperatively. CONCLUSION: PEG, PED PEJ and DPEJ are easily handled, effective and safe, and may be widely used in clinical practice.

Adult↗

PubMed1990

[New material for needle jejunostomy: technique and preliminary results].

New material for needle jejunostomy was evaluated. They have the following advantages: rapidity and ease of use in jejunostomy, the possibility of a high daily calorie intake, a cutaneous fixation system allowing cleaning of the feeding tube stoma. The material is presented and the insertion technique is described. The preliminary results in 30 patients showed no mortality or morbidity related to the jejunostomy. The authors stress the importance of performing needle jejunostomy whenever long-term high calorie intake is required after the operation.

Digestive System Diseases↗

PubMed1990

A reproducible, safe jejunostomy replacement technique by a percutaneous endoscopic method.

Patients undergoing esophagogastrectomy for cancer often benefit from postoperative nutritional support and an operative jejunostomy is frequently placed at the time of surgery. If the original tube has been removed, replacement of this jejunostomy previously required repeat laparotomy. Described here is the technique of direct percutaneous endoscopic jejunostomy placement (PEJ) used in two such patients following esophagogastrectomy. This PEJ placement technique using a #16-Fr, Pezzer-type Ponsky tube is an easy, reproducible method for the replacement of an operative jejunostomy tube. The fibrosed tract between the abdominal wall and jejunum allows the safe performance of the procedure if one endoscopically identifies the site of operative insertion.

Esophagostomy↗

PubMedDate not supplied

[Surgical jejunostomy as a route for enteral nutrition].

Ostomies are the nutritional route of choice when artificial nutrition could be necessary during more than thirty days. The surgical jejunostomy (SJ) is especially indicated in the patient undergoing major surgery of the digestive tract and the complications thereof. The present retrospective revision includes 57 cases of SJ followed during more than five days. The patients needed surgical treatment in nearly 80%. For the SJ the Witzel technique was used, with 18 Fr or more catheters. The mixes used were polymeric, in a closed circuit. The patients were a mean 60 +/- 13 years of age and 68.4% were male. They presented a medium level of undernourishment, with a 13% weight loss and a mean albumin level of 30.6 +/- 6.8 g/1000 cc. The Index of Nutritional Risk on average was 71.7 (normal 100). Complications appeared in 9/57 cases (15.7%), with the jejunostomy beginning to be used on average 2.3 +/- 2.4 days after surgery. Some form of support previous to the SJ was necessary in 31/57 patients, and 37/57 had another nutritional route in addition to the jejunostomy during an average of 8.9 +/- 11.1 days. In 49/57 patients (85.9%), 75% of the estimated calories were obtained in an average of 6.4 +/- 4.0 days, and in 42/57 patients (73.6%), 100% of the calories were obtained in an average of 8.6 +/- 3.0 days. Intolerance to the artificial nutrition occurred in 29/57 cases (50.8%), with diarrhoea being the most frequent in 16/57 (28.0%). The jejunostomy lasted for a mean of 28.4 +/- 43.0 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

[Celioscopic gastrostomies and jejunostomies].

The authors describe a technique of laparoscopic gastrostomy and jejunostomy, which has been used in 23 patients between May 1991 and August 1992: 13 laparoscopic gastrostomies (LG) and 10 laparoscopic jejunostomies (LJ), all performed under general anaesthesia. There were no operative deaths, one intraoperative complication and 3 postoperative complications. Twelve patients had died by the end of the study, 7 patients were still using their feeding tube and 4 patients ate normally. The mean duration of use of the feeding tubes was 4 months for LG and 43 days for LJ. The secondary complications consisted of 3 tube obstructions and one case of pyloric obstruction. Laparoscopic gastrostomy and jejunostomy, performed according to the method described, constitute an effective and reliable alternative to open operations. They can be performed in cases in which endoscopic gastrostomy is impossible. Due to its technical simplicity, laparoscopic jejunostomy should be preferred to gastrostomy whenever there is a risk of inhalation.

Acute Disease↗

PubMed1997

Complications associated with use of jejunostomy tubes in dogs and cats: 40 cases (1989-1994).

OBJECTIVE: To evaluate complications and outcomes of surgeries in which jejunostomy tubes were used in critically ill dogs and cats. DESIGN: Retrospective review of medical records. ANIMALS: 32 dogs and 8 cats. PROCEDURE: In each animal, a 5-F or 8-F red rubber urethral/feeding catheter was surgically placed in the proximal portion of the jejunum. RESULTS: The most common indication for jejunostomy tube placement in dogs was a gastrointestinal condition (20 dogs; 62.5%). Neoplasms were detected in 11 of the 20 dogs. Pancreatic disease was the most common indication for tube placement in cats (7 cats; 87.5%). Thirty-three animals (27 dogs, 6 cats; 82.5%) did not have complications. Five dogs and 2 cats had 10 tube-related complications, including focal cellulitis (3 dogs), tube dislodgement (2 dogs, 1 cat), and tube occlusion (1 dog, 1 cat). Twenty-four animals (20 dogs, 4 cats; 60%) were discharged from the hospital. Fifteen dogs and 4 cats were alive 2 weeks after discharge, and 5 dogs and 2 cats survived for at least 4 weeks after discharge. Deaths were related to disease and were not associated with jejunostomy tubes. CLINICAL IMPLICATIONS: The complication rate associated with jejunostomy tubes appears to be low. Complications usually are nonfatal.

Animals↗

PubMed1981

Feeding jejunostomy in patients with neurologic disorders.

A retrospective study of 54 patients who underwent feeding jejunostomy because of dysphagia on a neurologic basis was performed to determine risk factors affecting a postoperative mortality of 33% and six-month mortality of 67%. Advanced patient age, depressed preoperative level of consciousness, general anesthesia, and the technique of Witzel's jejunostomy were associated with increased postoperative level of consciousness carried an especially poor six month prognosis. It is concluded that a Roux-en-Y jejunostomy should be considered in patients with a hopelessly irreversible neurologic deficit. In all other situations, Stamm's jejunostomy is the feeding procedure of choice.

Adolescent↗

PubMed1983

Role of Roux-en-Y feeding jejunostomy for patients with acute head injury.

The total care of a patient with severe head injury is challenging and may extend for weeks, months, or even years. A major challenge of this care includes nutritional support: swallowing is impaired, aspiration accompanies gastric tube feeding, parenteral nutrition is limited to short term in hospital care, and needle jejunostomy or transabdominal jejunostomy are prone to inadvertent removal. The role of Roux-en-Y feeding jejunostomy was evaluated in 13 patients with acute head injury. Procedure related complications include prolapse of the ostomy (1 patient) and stoma-ischemia requiring revision (1 patient). The effect of ostomy tube feedings on gastric acid secretions was studied in five patients, and no significant change was noted when saline feeding was compared to blenderized diet feeding. Blenderized diet feedings were advanced gradually, and antidiarrheals were added as needed once gastrointestinal function returned. In conclusion, Roux-en-Y feeding jejunostomy provides an attractive, safe method for long-term enteral nutrition in the head injury patient. Easy replacement of the feeding tube facilitates nursing care, and the threat of acid-induced stress gastric bleeding is not enhanced.

Adult↗

PubMed1983

Proximal diverting jejunostomy for compromised small bowel.

The use of a totally diverting proximal jejunostomy in the surgical therapy of five cases of compromised small bowel is reported. In each case a diverting end-on jejunostomy was constructed 30 to 100 cm beyond the ligament of Treitz. The oversewn distal end of bowel was anchored intraperitoneally at the jejunum, and a tube was introduced into the distal intestine for subsequent radiologic study. In three of five cases small bowel leaks were demonstrated after operation by x-ray examination. The leaks caused no clinical problems. The jejunostomy remained in place for 4 to 13 weeks. The mean daily stoma output ranged from 200 to 2800 ml/day. Fluid and electrolyte losses were replaced and total parenteral nutrition was supplied. No stomal complications occurred. Intestinal continuity was restored when contrast medium passed through the intestine without leak or obstruction. Reanastomosis of the intestinal tract was accomplished with minimal dissection through a small peristomal incision because the distal closed end of the divided bowel had been fixed to the stoma base. Each of the patients recovered gastrointestinal function without further complication and was discharged from the hospital on a general diet. With parenteral nutritional support, a high jejunostomy is well tolerated. Proximal intestinal diversion can salvage an otherwise hopeless situation.

Adult↗

PubMed1983

Bacteriological analysis of jejunostomy fluid after surgery for extrahepatic biliary atresia.

Quantitative cultures were made of jejunostomy fluid from 22 children with extrahepatic biliary atresia following hepatoportoenterostomy. Bacterial flora characteristics did not differ in patients with or without cholangitis. With the exception of Streptococcus group D, the most frequently encountered bacterial species with the highest mean concentrations in the jejunostomy fluid, were those mostly responsible for cholangitis (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). In 19 of 22 acute episodes, the organism causing cholangitis identified in blood and/or liver was also isolated from jejunostomy fluid. However, quantitative determinations in this fluid did not permit reliable identification of this organism. When the same bacterium caused early relapse, it often persisted in the jejunostomy fluid.

Bacterial Infections↗

PubMed1999

Laparoscopic gastrostomy and jejunostomy: safety and cost with local vs general anesthesia.

BACKGROUND AND HYPOTHESIS: General anesthesia is used for laparoscopic enteral access because pneumoperitoneum requires relaxation of the abdominal muscles. We wanted to determine whether these procedures could be performed with similar results and cost under local anesthesia. DESIGN: Randomized controlled study with 30-day follow-up including a cost-benefit analysis. SETTING: University-affiliated hospitals. PATIENTS: Forty-eight patients (32 men, 16 women; mean age, 67 years) undergoing laparoscopic gastrostomies (n = 32) and jejunostomies (n = 16). INTERVENTION: Twenty-four patients underwent laparoscopic gastrostomy (n = 15) and jejunostomy (n = 9) under local anesthesia with intravenous conscious sedation and monitored anesthesia care. Twenty-four patients had general anesthesia. MAIN OUTCOME MEASURES: Conversion to general anesthesia, complications, and cost. RESULTS: Ten patients under local anesthesia had periods of deep sedation and 1 required conversion to general anesthesia. One patient under general anesthesia required conversion to open gastrostomy. No patients had intraoperative aspiration; however, 4 aspirated after the procedure. One patient died of myocardial infarction during the 30-day follow-up. We found no significant difference in the total mean cost and actual procedure time. The surgeon's fee accounted for 31% of the total cost. CONCLUSIONS: Some patients undergoing laparoscopic enteral access may require deep sedation and a rare patient may require general anesthesia. Clinical conditions and surgeon preference, therefore, should determine whether local anesthesia is suitable for laparoscopic gastrostomies and jejunostomies, and in what setting, since there is no difference in success rate or complications when compared with general anesthesia. Potential savings are possible from the operating room (26% of total cost) or anesthesiologist (12% of total cost) if these procedures are performed in an endoscopy suite without monitored anesthesia care.

Aged↗

PubMed1993

Laparoscopic jejunostomy using T-fasteners as retractors and anchors.

We developed a new technique for performing laparoscopic jejunostomies using T-fasteners to secure the jejunum to the abdominal wall. The proximal jejunum is identified with laparoscopy. Four T-fasteners are introduced percutaneously into the jejunal lumen for retraction, and an 8F catheter is inserted through a peel-away introducer via a J-wire. The jejunum is drawn up against the abdominal wall by pulling on the T-fasteners. Tube placement is checked with laparoscopy and roentgenography. We performed laparoscopic jejunostomies in five patients using this method, and the results were excellent. Jejunostomies can be performed safely, easily, and reliably this way.

Adult↗

PubMed1999

Complications associated with enteral nutrition using catheter jejunostomy after esophagectomy.

The present study was conducted on 78 patients, encountered over a 7-year period, who had a catheter-feeding jejunostomy placed at the time of thoracoabdominal esophagectomy for esophageal cancer. A broad-based attachment of the jejunal wall to the peritoneum at the place of entry of the catheter was used. Enteral nutrition was begun an average of 10 days after the operation, the caloric content was increased gradually, and the mean duration was 69 days. There were three patients who suffered from local skin erosion at the site of catheter entry, and seven who developed diarrhea and/or a feeling of abdominal fullness, but none of the patients showed any signs of peritonitis or ileus. The morbidity rates related to enteral nutrients and placement of the catheter jejunostomy were 8.9% and 3.8%, respectively. These findings demonstrate that a broad-based attachment of the jejunal wall to the peritoneum at the place of entry of the catheter is useful for preventing leakage or twisting of the jejunum, and for reducing the incidence and severity of the complications of catheter jejunostomy feeding.

Catheterization↗

PubMed2006

Improvement in the quality of life using both Bianchi's procedure and the closure of a jejunostomy in a case with short bowel syndrome.

In cases with short bowel syndrome (SBS), intestinal adaptation often requires a long time. In addition, the quality of life in SBS is not especially good due to some complications, including growth impairment, severe diarrhea, complications of parenteral nutrition (PN), and so on. We herein report an adolescent boy with SBS secondary to midgut volvulus. He suffered mainly from both severe high output syndrome, which caused a large amount of enteric fluid to flow out from the jejunostomy, and growth impairment, although PN continued after the occurrence of SBS. As a result, he thereafter could not continue his daily school life. Therefore, he was introduced to our department at 6 months after the operation. A closure of the jejunostomy combined with longitudinal intestinal lengthening using Bianchi's procedure was performed. Thereafter, the above-described symptoms disappeared. He was discharged and thereafter was again able to attend school with an improvement in his growth within 2 months after the second operation. Home PN was discontinued at 15 months after the second operation. Based on our experience, in cases of SBS without intestinal functional disorder, an early closure of the jejunostomy combined with Bianchi's procedure might therefore possibly lead to an early improvement in the complications related to SBS.

Adolescent↗

PubMed2003

Enteral migration of a Pezzer tube after a feeding jejunostomy: report of a case.

We herein report a rare complication of the migration of a feeding jejunostomy tube through the entire intestine. A surgical Stamm jejunostomy was performed in a patient with an unresectable gastric cancer using a 28-F silicone catheter with a mushroom tip (Pezzer catheter). The catheter was suture-fixed to the skin, family members were given instructions regarding tube feeding and tube care, and the patient was discharged to home care. Two months later, he presented because of the "disappearance" of the tube. A clinical examination revealed a mature jejunostomy tract, skin erosion at the site where the suture was placed, and absence of the tube. There were no signs of intestinal obstruction or peritonitis. Abdominal X-ray examination showed the catheter inside the jejunum. The patient was treated conservatively with serial radiographs showing rapid tube migration through the intestine, and the tube was eliminated spontaneously 5 days later. An awareness of this complication and its appropriate treatment is important given the widespread use of enteral nutrition.

Aged↗