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Adult Intestinal Intussusception Caused by the Gastrojejunostomy Tube: An Endoscopically Treatable Phenomenon. Case Rep Gastrointest Med 2021; 2021:4325443. [PMID: 34221519 PMCID: PMC8213475 DOI: 10.1155/2021/4325443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Adult duodenoduodenal intussusception is extremely rare due to the retroperitoneal fixation of the second, third, and fourth parts of the duodenum. A majority of clinically significant intussusception with identifiable etiologies is typically neoplastic with more rare causes including retained food and indwelling enteral tubes, specifically with gastrojejunostomy (GJ) tubes. Herein, we discuss the case of a 23-year-old male who developed duodenoduodenal intussusception upon a PEGJ placement with associated gastroduodenal dilation and telescope phenomenon. To the best of our knowledge, there are no reports of intussusception found to be caused by GJ tubes in the adult population. The reported patient was found to have a 4-cm enteroenteric intussusception without obstruction or ischemia with bowel thickening proximal to the pathology. Although adult intussusception cases are typically managed surgically, we were able to reduce the intussusception via endoscopy due to rapid diagnosis upon presentation and intervention before the bowel wall could be compromised.
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Dutta S, Gaur NK, Reddy A, Jain A, Nelamangala Ramakrishnaiah VP. Antegrade Jejunojejunal Intussusception: An Unusual Complication Following Feeding Jejunostomy. Cureus 2021; 13:e13264. [PMID: 33728200 PMCID: PMC7948317 DOI: 10.7759/cureus.13264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Feeding jejunostomy (FJ) is a simple surgical procedure for enteral nutrition. But it can develop complications that may require re-exploration and can be life-threatening. Common complications include mechanical ones such as tube migration or dislocation, infection, gastrointestinal symptoms and fluid and electrolyte imbalances. However, intussusception is a rare complication of FJ. A 54-year-old gentleman underwent a D2 subtotal gastrectomy with Roux-en-Y gastrojejunostomy with FJ. On the sixth postoperative day, he developed severe colicky pain associated with abdominal distension and bilious vomiting. Ultrasonography and computed tomography revealed a 10-cm long jejunojejunal intussusception with the FJ tube at the center of the intussusception with proximal jejunal loops' distension. The patient was taken up for a re-exploratory laparotomy with manual reduction of the intussusception and a new FJ insertion distal to the previous enterotomy site. The patient had an uneventful postoperative recovery.
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Affiliation(s)
- Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Chawla S, Sureka B, Varshney VK, Nayar R, Sreesanth KS. A Rare Complication of Feeding Jejunostomy: Murky Waters of the Surgeons. Cureus 2021; 13:e12945. [PMID: 33659108 PMCID: PMC7920236 DOI: 10.7759/cureus.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Feeding jejunostomy (FJ) is a common surgical procedure for patients presenting with absolute dysphagia. Jejunostomy tube-induced intussusception is an extremely rare complication associated with it and its recognition and proper management are necessary to prevent subsequent bowel ischemia of the intussusception. We present a rare case with simultaneous intussusception at two sites in a patient who underwent FJ with Foley’s catheter one month back and subsequently managed by surgical reduction and repositioning of the FJ tube.
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Affiliation(s)
- Siddhi Chawla
- Diagnostic & Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Binit Sureka
- Diagnostic & Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Vaibhav K Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Raghav Nayar
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Kelu S Sreesanth
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
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Mathew RP, Sam M, Alexander T, Patel V, Low G. Abdominal and pelvic radiographs of medical devices and materials-Part 1: gastrointestinal and vascular devices and materials. ACTA ACUST UNITED AC 2020; 26:101-110. [PMID: 32071024 DOI: 10.5152/dir.2019.19390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
When compared with chest radiographs, medical devices of the abdomen and pelvis are less frequently seen. However, with recent advances in technology the interpreting radiologists are seeing more medical objects on these radiographs. The identification of these devices and materials are crucial for not only enabling the radiologist to understand the underlying background pathology but also for evaluating any related complications. An online survey of literature showed our review article to be the most detailed. In this first part of our two-part series, we discuss about the various gastrointestinal and vascular devices and materials seen on abdominal and pelvic radiographs.
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Affiliation(s)
- Rishi Philip Mathew
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Timothy Alexander
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
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Jejunojejunal intussusception following jejunostomy closure: A case report. Int J Surg Case Rep 2020; 76:446-449. [PMID: 33207409 PMCID: PMC7599362 DOI: 10.1016/j.ijscr.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intussusception can occur anywhere in the small and large bowel, ileocolic intussusception is the most common type in adult and there are few reported cases of jejunojejunal intussusception. Here we report a case of jejunojejunal intussusception due to an iatrogenic lead point at the feeding jejunostomy closure site. CASE PRESENTATION In 2019 we received a 63-year-old female complaining of abdominal pain, constipation, and repeated vomiting for five days. On physical examination, she was dehydrated, in pain, and had a nasogastric tube that was draining bilious fluid. The abdomen was tender, there was a long midline incision with tension sutures at the lower of incision. CT of the abdomen showed ileoileal intussusception. Proper resuscitation and preoperative preparation were done. During exploratory laparotomy, there was jejunojejunal intussusception. The intussusception was reduced gently and completely. Resection of the lead point segment done with end to end anastomosis. The patient recovered uneventfully and discharged home on the 5th postoperative day. The patient followed up after one and three months with no complications. CONCLUSION During the closure of the feeding jejunostomy site by hand-sewn technique, over invagination of the second (seromuscular) layer of the wall of the jejunum might become so thick at the site of the closure that it acts as a lead point for intussusception. We reported a case of such a scenario.
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Harano T, Sanchez PG, Bauza G, McDyer JF, D'Cunha J. Jejuno-jejunal intussusception in a post-lung transplant patient from a gastrojejunostomy tube: A case report. Int J Surg Case Rep 2019; 55:129-131. [PMID: 30731299 PMCID: PMC6365386 DOI: 10.1016/j.ijscr.2019.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Gastro-jejunostomy tube is used for post-pyloric feeding for critical-ill patient who cannot tolerate oral alimentation. Jejuno-jejunal intussusception is a rare complication of gastrojejunostomy tube. PRESENTATION OF CASE A 39-year-old male with history of severe combined immunodeficiency, Achalasia and end-stage lung disease underwent double lung transplantation. After lung transplantation, he required gastrojejunostomy(GJ) tube placement due to his esophageal disease. Four days after gastrojejunostomy tube placement, he developed jejuno-jejunal intussusception. A 15 cm segment of thickened and enlarged bowel, which consisted of the intussusception were identified laparoscopically. Surgical reduction was performed without bowel resection. DISCUSSION Intussusception is uncommon in adults compared to pediatric population. In this rare case, the jejunal limb of the GJ tube placed in jejunum was the cause of jejunojejunal intussusception serving as the lead point. The GJ tube should not be placed farther down from ligaments of Treiz to prevent jejuno-jejunal intussusception. CONCLUSIONS A heightened index of suspicion for this rare complication should exist with a presenting patient has signs of proximal bowel obstruction and CT evidence of intussusception.
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Affiliation(s)
- Takashi Harano
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Graciela Bauza
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - John F McDyer
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
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Nishizawa T, Ohki Y, Urano H, Suzuki T, Kuwashima M. Knotted transpyloric tube in an infant. Pediatr Int 2018; 60:310-311. [PMID: 29431242 DOI: 10.1111/ped.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/15/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Takuya Nishizawa
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Yasushi Ohki
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Hironaka Urano
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Takahiro Suzuki
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Makoto Kuwashima
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
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Dholaria S, Lakhera KK, Patni S. Intussusception: a Rare Complication After Feeding Jejunostomy; a Case Report. Indian J Surg Oncol 2016; 8:188-190. [PMID: 28546717 DOI: 10.1007/s13193-016-0604-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/01/2016] [Indexed: 01/11/2023] Open
Abstract
Feeding jejunostomy (FJ) is a commonly done surgical procedure for enteral nutrition. Intussusception is one of the rare complications of FJ. Clinical presentation may be similar to other causes of small bowel obstruction. Intussusception should be suspected if a patient with jejunostomy tube develops upper gastrointestinal obstructive symptoms, which are relieved by nasogastric tube drainage. CT or ultrasonography (USG) can help to confirm the diagnosis. It can be relieved spontaneously or sometimes requires laparotomy. We have encountered such complication in one patient. The patient developed intestinal obstruction after removal of FJ tube and was diagnosed as having intussusception radiologically. On exploration, intussusception was identified at FJ site for which surgical reduction was done.
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Affiliation(s)
- Shreyas Dholaria
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
| | - Sanjeev Patni
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
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Abstract
Obtaining reliable enteral and vascular access constitutes a significant fraction of a pediatric surgeon׳s job. Multiple approaches are available. Given the complicated nature of this patient population multiple complications can also occur. This article discusses the various techniques and potential complications associated with short- and long-term enteral and vascular access.
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Affiliation(s)
- James S Farrelly
- Division of Pediatric General and Thoracic Surgery, Yale Children's Hospital, Yale University School of Medicine, PO Box 208062, New Haven, Connecticut 06520-8062
| | - David H Stitelman
- Division of Pediatric General and Thoracic Surgery, Yale Children's Hospital, Yale University School of Medicine, PO Box 208062, New Haven, Connecticut 06520-8062.
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Jejunojejunal intussusception: an unusual complication after feeding jejunostomy. Indian J Surg Oncol 2013; 4:383-4. [PMID: 24426764 DOI: 10.1007/s13193-013-0271-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022] Open
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Krishna S, Prabhu R, Thangavelu S, Shenoy R. Jejuno-jejunal intussusception: an unusual complication of feeding jejunostomy. BMJ Case Rep 2013; 2013:bcr-2013-200219. [PMID: 23814219 DOI: 10.1136/bcr-2013-200219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The jejuno-jejunal intussusception is a rare complication of jejunostomy tube placement. We are reporting a case of 33-year-old man who was suffering from absolute dysphagia due to carcinoma of cricopharynx with advanced metastatic disease, who underwent Stamms feeding jejunostomy as a part of palliative care. After 1 month he presented with colicky type of pain in the abdomen and vomiting. Sonogram of abdomen revealed a target sign and a feeding tube in a dilated jejunum. Abdominal CT proved the sonographic impression of jejuno-jejunal intussusception. He, therefore, underwent exploratory laparotomy and resection and anastomosis of the intussuscepted bowel. New feeding jejunostomy (FJ) was done distally from the anastomotic site. As per the literature this complication has been reported in Witzels jejunostomy. In our case the patient had undergone Stamms jejunostomy with placement of a Ryle's tube. Intussusception should be considered if a patient comes with abdominal pain and vomiting following FJ.
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12
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Thompson ZM, Lebowitz EA. Ultrasound-guided puncture of an obstructing migratory jejunostomy tube. J Vasc Interv Radiol 2008; 20:137-8. [PMID: 19010056 DOI: 10.1016/j.jvir.2008.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 11/18/2022] Open
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Abstract
A 45-year-old Costa Rican woman was seen for a jejunostomy tube malfunction. There was no evidence of tube malposition or intestinal obstruction. During endoscopy, a long worm was retrieved from the distal duodenum; it was later confirmed to be Ascaris lumbricoides. After treatment with mebendazole, no further episodes of tube occlusion were observed. This case reminds us of the importance of considering helminthic infections and their atypical manifestations in patients from endemic regions.
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Cavanaugh RP, Kovak JR, Fischetti AJ, Barton LJ, Bergman P. Evaluation of surgically placed gastrojejunostomy feeding tubes in critically ill dogs. J Am Vet Med Assoc 2008; 232:380-8. [DOI: 10.2460/javma.232.3.380] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liao GS, Hsieh HF, Wu MH, Chen TW, Yu JC, Liu YC. Knot formation in the feeding jejunostomy tube: A case report and review of the literature. World J Gastroenterol 2007; 13:973-4. [PMID: 17352035 PMCID: PMC4065941 DOI: 10.3748/wjg.v13.i6.973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Jejunostomy feeding tubes provide surgeons with an excellent method for providing nutritional support, but there are several complications associated with a tube jejunostomy, including complications resulting from placement of the tube, mechanical problems related to the location or function and development of focally thickened small-bowel folds. A 76-year old man who presented with multiple medical diseases was admitted to our hospital due to aspiration pneumonia with acute respiratory failure and septic shock. He underwent exploratory laparotomy with feeding jejunostomy using a 14-French nasogastric tube for nutritional support. However, occlusion of the feeding tube was found 30 d after operation, and a rare complication of knot formation in the tube occurred after a new tube was replaced. On the following day, the tube was removed and replaced with a similar tube, which was placed into the jejunum for only 15 cm. The patient’s feedings were maintained smoothly for two months. Knot formation in the feeding tube seems to be very rare. To our knowledge, this is the third case in the literature review. Its incidence is probably related to the length of the tube inserted into the lumen.
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Affiliation(s)
- Guo-Shiou Liao
- Department of Surgery, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Taiwan, China
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Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. AJR Am J Roentgenol 2007; 188:275-9. [PMID: 17179377 DOI: 10.2214/ajr.05.2049] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether there are clinical or sonographic findings that can be used to differentiate benign self-limited small-bowel intussusception from pathologic small-bowel intussusception that necessitates surgical intervention. MATERIALS AND METHODS A retrospective search was performed of abdominal sonograms obtained at two institutions between January 1996 and June 2005. Sonographic findings were correlated with medical and surgical records. RESULTS A total of 35 cases of isolated small-bowel intussusception were found. Thirteen (37%) of these cases necessitated surgical intervention, and 22 (63%) of the cases were benign and self-limiting. Patients with self-limiting intussusception were younger than patients with intussusception necessitating surgical intervention (mean, 4.2 vs 7.5 years; p = 0.0327). Abdominal sonograms depicted ascites and small-bowel obstruction significantly more frequently in patients with small-bowel intussusception necessitating surgery (n = 7 [54%] for each finding) than in patients with self-limiting intussusception (n = 2 [9%], n = 0) (p = 0.006 and p = 0.0003, respectively). At sonography, patients who later underwent surgical intervention had small-bowel intussusception of significantly greater length (mean, 7.3 cm) than those treated conservatively (mean length, 1.9 cm) (p < 0.0001). Intussusception length greater than 3.5 cm was considered a sensitive and specific independent predictor of the need for surgery (sensitivity, 93%; specificity, 100%). CONCLUSION When small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need for surgical intervention.
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Affiliation(s)
- Martha M Munden
- Edward B. Singleton Diagnostic Imaging Services, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030-2399, USA
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Lobo DN, Williams RN, Welch NT, Aloysius MM, Nunes QM, Padmanabhan J, Crowe JR, Iftikhar SY, Parsons SL, Neal KR, Allison SP, Rowlands BJ. Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: A prospective, randomized, controlled, double-blind study. Clin Nutr 2006; 25:716-26. [PMID: 16777271 DOI: 10.1016/j.clnu.2006.04.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 04/14/2006] [Accepted: 04/21/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND The provision of perioperative immune modulating enteral feeds after major surgery may result in reduced infective complications, but meta-analyses have not demonstrated a survival advantage. The aim of this study was to determine whether early postoperative immune modulating jejunostomy feeding results in reduced infective complications in patients undergoing resectional surgery for upper gastrointestinal cancer. METHODS A total of 120 patients undergoing resection for cancers of the pancreas, oesophagus and stomach were randomized in a double-blind manner to receive jejunostomy feeding with an immune modulating diet (Stresson-Group A) or an isonitrogenous, isocaloric feed (1250 Calories and 75 g protein/l--Nutrison High Protein-Group B) for 10-15 days. Feeding was commenced 4h postoperatively and continued for 20 h/day. The target volume (ml/h) was 25 on day 0, 50 on day 1, and 75 thereafter. Outcome measures included complications, hospital stay and mortality. RESULTS A total of 108 patients (54 in each group) were analysed. Feed delivery, although less than targeted, was similar in both groups. There were 6 (11%) deaths in each group. Median (IQR) postoperative hospital stay was 14.5 (12-23) days in Group A and 17.5 (13-23) days in Group B (P=0.48). A total of 24 (44%) patients in each group had infective complications (P=1.0). A total of 21 (39%) patients in Group A and 28 (52%) in Group B had non-infective complications (P=0.18). Jejunostomy-related complications occurred in 26 (48%) patients in Group A and 30 (56%) in Group B (P=0.3). CONCLUSION Early postoperative feeding with an immune modulating diet conferred no outcome advantage when compared with a standard feed.
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Affiliation(s)
- Dileep N Lobo
- Section of Surgery, University Hospital, Queen's Medical Centre, E Floor, West Block, Nottingham NG7 2UH, UK.
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18
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Abstract
Jejunojejunal intussusception is a rare complication of jejunostomy, and its preoperative diagnosis and surgical treatment have not been reported. A 78-year-old man suffered from vomiting off and on after emergency exploratory laparotomy with omentoplasty for perforated duodenal ulcer. He also received Witzel jejunostomy for early feeding. Ileus developed postoperatively and plain X-ray of the abdomen showed distended small bowel loop with scanty colon gas. Small bowel series performed with water-soluble contrast medium revealed substantial fluid retention in the stomach, duodenum and proximal jejunum. Infusion of contrast medium into the feeding tube revealed normal caliber of the distal small bowel. Abdominal sonogram revealed target sign as well as the feeding tube in a dilated jejunum. Abdominal computed tomography confirmed the sonographic impression of jejunojejunal intussusception. Reduction of intussusception was done during exploratory laparotomy. The jejunostomy feeding was continued and the postoperative course was uneventful.
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Affiliation(s)
- Tsung-Hsien Wu
- Department of Surgery, Buddhist Hualien Tzu Chi General Hospital, Dalin, Taiwan
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19
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Abstract
Enteral is preferred to parenteral nutritional support for acute and chronic diseases because it is more physiological and associated with fewer infection complications. Nasal tube feedings are generally used for 30 days or less and percutaneous access for the longer-term. Feeding by naso-gastric tubes is appropriate for most critically ill patients. However, trans-pyloric feeding is indicated for those with regurgitation and aspiration of gastric feeds. Deep naso-jejunal tube feeding is appropriate for patients with severe acute pancreatitis. There are several methods for endoscopic placement of naso-enteric tubes. Percutaneous endoscopic gastrostomy is used for most persons requiring long-term support. Long-term jejunal feeding is most often used for persons with chronic aspiration of gastric feeds, chronic pancreatitis intolerant to eating, or persons in need of concomitant gastric decompression. Percutaneous endoscopic gastrostomy with a jejunal tube extension is fraught with tube dysfunction and dislocation. Direct percutaneous endoscopic jejunostomy tubes may be more robust, but are less commonly performed.
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Affiliation(s)
- James A DiSario
- University of Utah Health Sciences Center, 30 North 1900 East, 4R 118, Salt Lake City, UT 84132, USA.
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20
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Abstract
Perforations of the gastrointestinal tract have many causes. Holes in the wall of gastrointestinal organs can be created by blunt or penetrating trauma, iatrogenic injury, inflammatory conditions that penetrate the serosa or adventitia, extrinsic neoplasms that invade the gastrointestinal tract, or primary neoplasms that penetrate outside the wall of gastrointestinal organs. This article provides a radiologic approach for investigating the wide variety of gastrointestinal perforations. General principles about contrast agents and studies are reviewed, and then perforations in specific gastrointestinal organs are discussed.
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Affiliation(s)
- Stephen E Rubesin
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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21
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Abstract
The small bowel is subject to a variety of surgical interventions for the treatment of a broad spectrum of disease processes. Most operative procedures applied to the small bowel are straightforward techniques encumbered by few complications, whereas other procedures are considerably more complex and can be associated with significant postoperative morbidity. Familiarity with the anatomic alterations related to the various operations is essential, both for evaluation of early postoperative complications and those abnormalities that manifest late in the postoperative course. The surgeon and radiologist should carefully coordinate clinical suspicion with the strengths of the various imaging modalities to optimize postsurgical assessment and provide timely and accurate diagnosis. Enteric anastomoses, the different forms of enterostomy, and the varied constructions of small bowel pouches and reservoirs are each associated with unique anatomy and therefore optimal techniques of assessment. Small bowel contrast studies such as enteroclysis--including its recent modification, CT enteroclysis--and CT imaging represent the primary modalities for imaging of the postoperative bowel and its related abnormalities. Small bowel transplantation continues to progress as a realistic treatment for intestinal failure, and the role of diagnostic imaging in these unique and challenging patients is evolving.
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Affiliation(s)
- John C Lappas
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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