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Tube Feed Necrosis after Major Gastrointestinal Oncologic Surgery: Institutional Lessons and a Review of the Literature

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Small bowel necrosis after enteral feeding through a jejunostomy tube (tube feed necrosis, TFN) is a rare, serious complication of major abdominal surgery. However, strategies to reduce the incidence and morbidity of TFN are not well established. Here, in the largest series of TFN presented to date, we report our institutional experience and a comprehensive review of the literature.

Methods

Eight patients who experienced TFN from 2000 to 2014 after major abdominal surgery for oncologic indications at the University of Cincinnati were reviewed. Characteristics of post-operative courses and outcomes were reviewed prior to and after a change in tube-feeding protocol. The existing literature addressing TFN over the last three decades was also reviewed.

Results

Patients with TFN ranged from 50 to 74 years old and presented with upper gastrointestinal tract malignancies amenable to surgical resection. Six and two cases of TFN occurred following pancreatectomy and esophagectomy, respectively. Prior to TF protocol changes, which included initiation at a low rate, titrating up more slowly and starting at one-half strength TF, three of six cases of TFN (50%) resulted in mortality. With the new TF protocol, there were no deaths, goal TF rate was achieved 3 days later, symptoms of TFN were recognized 3 days earlier, and re-operation was conducted 1 day earlier.

Conclusion

This case series describes a change in clinical practice that is associated with decreased morbidity and mortality of TFN. Wider implementation and further refinement of this tube-feeding protocol may reduce TFN incidence at other institutions and in patients with other conditions requiring enteral nutrition.

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Author information

Authors and Affiliations

  1. College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    S. A. Sethuraman & D. A. Habib

  2. Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    V. K. Dhar, J. E. Sussman, S. A. Ahmad, S. A. Shah, B. J. Tsuei & J. J. Sussman

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/742, Madison, WI, 53792, USA

    Daniel E. Abbott

Authors
  1. S. A. Sethuraman
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  2. V. K. Dhar
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  3. D. A. Habib
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  4. J. E. Sussman
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  5. S. A. Ahmad
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  6. S. A. Shah
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  7. B. J. Tsuei
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  8. J. J. Sussman
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Contributions

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Journal of Gastrointestinal Surgery.

Category 1

Conception and design of study:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Acquisition of data:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Analysis and/or interpretation of data:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Category 2

Drafting the manuscript:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Revising the manuscript critically for important intellectual content:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Category 3

Final approval of the version of the manuscript to be published:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Category 4

Agreement to be accountable for all aspects of the work:

Sethuraman SA, Dhar VK, Habib DA, Sussman JE, Ahmad SA, Shah SA, Tsuei B, Sussman JJ, Abbott DE.

Corresponding author

Correspondence to Daniel E. Abbott.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Synopsis: Review of a single-institution experience, with corresponding literature search, of patients developing tube feed necrosis after major abdominal oncologic surgery, comparing outcomes before and after adjustment in institutional tube-feeding protocols.

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Sethuraman, S.A., Dhar, V.K., Habib, D.A. et al. Tube Feed Necrosis after Major Gastrointestinal Oncologic Surgery: Institutional Lessons and a Review of the Literature. J Gastrointest Surg 21, 2075–2082 (2017). https://doi.org/10.1007/s11605-017-3593-9

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  • DOI: https://doi.org/10.1007/s11605-017-3593-9

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