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Jejunostomy
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Jejunostomy
Eliza Mędrek
Jejunostomy
What is it?
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 formal surgery
A jejunostomy may be formed following bowel resection in cases where there is a need for 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.
Short bowel syndrome (SBS, or simply short gut) is a malabsorption disorder caused by a lack of functional small intestine.[3] The primary symptom is diarrhea, which can result in dehydration, malnutrition, and weight loss.[1] Other symptoms may include bloating, heartburn, feeling tired, lactose intolerance, and foul-smelling stool.[1] Complications can include anemia and kidney stones.[2]
Most cases are due to the surgical removal of a large portion of the small intestine.[1] This is most often required due to Crohn's disease in adults and necrotising enterocolitis in young children.[2] Other causes include damage to the small intestine from other means and being born with an abnormally short intestine.[1] It usually does not develop until less than 2 m (6.6 ft) of the normally 6.1 m (20 ft) small intestine remains.[3][1]
Parenteral nutrition (PN) is the feeding of specialist nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by specialist pharmaceutical compounding companies and is considered to be the highest risk pharmaceutical preparation available as the products cannot undergo any form of terminal sterilization. The person receives highly complex nutritional formulae that contain nutrients such as glucose, salts, amino acids, lipids and added vitamins and dietary minerals. It is called total parenteral nutrition (TPN) or total nutrient admixture (TNA) when no significant nutrition is obtained by other routes, and partial parenteral nutrition (PPN) when nutrition is also partially enteric. It may be called peripheral parenteral nutrition (PPN) when administered through vein access in a limb rather than through a central vein as central venous nutrition (CVN).
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.
Jejunostomy
A jejunostomy tube is a feeding tube placed in the jejunum (middle section of the small intestine). This is done when the stomach has to be bypassed.
The tube
Title
The tube is put in place by one of these methods:
1. Surgical - the tube is secured to the skin by stitching the tube’s external fixation disc to it. Occasionally it may be secured by an internal fixation disc.
2. Via a PEG tube (a feeding tube placed into the stomach) - a much thinner jejunostomy extension tube is passed through the PEG tube into the jejunum. Careful placement of the jejunostomy tube is verified by X-Ray. The PEG tube is retained in the stomach by a disc to ensure it does not fall out. However, the jejunostomy extension tube is only secured by an adaptor at the end of the PEG tube.
3. Radiologically – the tube is placed under X-Ray control, and is usually secured by stitching the external fixation disc to the skin