Jejunostomy

Jejunostomy is the surgical creation of an opening (stoma) through the skin at the front of the abdomen and the wall of the jejunum (part of the small intestine). It can be performed either endoscopically, or with open surgery.[1]

Jejunostomy
Jejunostomy to the abdomen wall
ICD-9-CM46.32
MeSHD007582

A jejunostomy may be formed following bowel resection in cases where there is a need to bypassing the distal small bowel and/or colon due to a bowel leak or perforation. Depending on the length of jejunum resected or bypassed the patient may have resultant short bowel syndrome and require parenteral nutrition.[2]

A jejunostomy is different from a jejunal feeding tube which is an alternative to a gastrostomy feeding tube commonly used when gastric enteral feeding is contraindicated or carries significant risks. The advantage over a gastrostomy is its low risk of aspiration due to its distal placement. Disadvantages include small bowel obstruction, ischemia, and requirement for continuous feeding.[3]

Techniques

The Witzel jejunostomy is the most common method of jejunostomy creation.[4] It is an open technique where the jejunosotomy is sited 30 cm distal to the Ligament of Treitz on the antimesenteric border, with the catheter tunneled in a seromuscular groove

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References
  1. Pearce, C B; Duncan, HD (2002). "Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: Its indications and limitations". Postgraduate Medical Journal. 78 (918): 198–204. doi:10.1136/pmj.78.918.198. PMC 1742333. PMID 11930022.
  2. Nightingale, J; Woodward, JM; Small Bowel Nutrition Committee of the British Society of Gastroenterology (2006). "Guidelines for management of patients with a short bowel". Gut. 55 (Suppl 4): iv1–12. doi:10.1136/gut.2006.091108. PMC 2806687. PMID 16837533.
  3. Melis M1, Fichera A, Ferguson MK. (July 2006). "Bowel necrosis associated with early jejunal tube feeding: A complication of postoperative enteral nutrition". Arch Surg. 141 (7): 701–4. doi:10.1001/archsurg.141.7.701. PMID 16847244.CS1 maint: uses authors parameter (link)
  4. Tapia J, Murguia R, Garcia G, de los Monteros PE, Oñate E (1999). "Jejunostomy: techniques, indications, and complications". World Journal of Surgery. 23 (6): 596–602. doi:10.1007/pl00012353. PMID 10227930.


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