Jejunostomy
Jejunostomy is a surgical procedure by which an opening is created through the skin at the front of the abdomen and the wall of the jejunum.
Some facts about Jejunostomy:
- A feeding tube can be put into the small intestine by the process of Jejunostomy.
- A jejunostomy can be performed following bowel resection in cases where there is a need to bypass the distal small bowel and/or colon due to a bowel leak or perforation.
- The patient may have resultant short bowel syndrome and require parenteral nutrition depending on the length of jejunum resected or bypassed.
- Jejunostomy is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those in a hypercatabolic state, those with a prolonged fasting period, or those who will subsequently need chemotherapy or radiotherapy.
Preparation for Jejunostomy:
- Avoid eating and drinking anything at least four hours before your surgery.
- You may drink a sip of water with your medications if needed.
- Any history of bleeding disorders or are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting should be informed to your healthcare provider as you may be asked to stop taking these medicines before your surgery.
- The possible complications and side effects, the risks, and what the operation involves will be discussed with you by your doctor.
- You might be given fluids through a drip intravenously, directly into a vein so that you don't get dehydrated.
Procedure for Jejunostomy:
- Jejunostomy can be performed either endoscopically, or with open surgery.
- Longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy are some of the techniques used for jejunostomy.
- Jejunostomy is as an additional procedure during major surgery of the upper digestive tract.
- Nutrition can be infused at the level of the jejunum irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts.
- The most common method of jejunostomy creation is Witzel jejunostomy in which the jejunosotomy is sited 30 cm distal to the Ligament of Treitz on the antimesenteric border, with the catheter tunneled in a seromuscular groove.
- It is an open technique.
- Fluoroscopic guidance is used for the procedure.
- Your stomach will be inflated using a nasogastric tube by the interventional radiologist which will aid the fluoroscopy, the required puncture and enlargement of the tract.
- Nasogastric access may not be possible in some cases. Then the stomach is inflated using a needle introduced into the stomach, under image guidance in such cases.
- The interventional radiologist may administer a contrast liquid into your colon the day before the jejunostomy procedure, to help visualize the colon so that the risk of puncturing the colon can be minimized.
- The skin where the tube will be inserted will be punctured by the interventional radiologist during the jejunostomy procedure, and then the needle will be directed under image guidance to the small intestine.
- The needle may be attached to an anchor, which will be directed into the jejunum using a guidewire.
- The tract will be expanded using dilators or tiny balloons to ensure there is enough space for the tube.
- A separate guidewire will be used for this purpose.
- A jejunostomy tube will be inserted over the guidewire, using fluoroscopy to confirm its position.
- The guidewires will be removed once it has been confirmed that the tube is correctly placed and the tube will be secured to the skin using anchors
Complications of Jejunostomy:
- Tube dislocation, obstruction or migration of the tube, enterocutaneous fistulas, cutaneous or intraabdominal abscesses, pneumatosis, occlusion, and intestinal ischemia are some of the moderate and severe complications of this surgery.
- Aspiration pneumonia and contamination of the diet are the infectious complications.
- Diarrhea, abdominal distension, colic, constipation, nausea, and vomiting are the gastrointestinal complications.
- Hyperglycemia, hypokalemia, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia are the metabolic complications.
