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Feeding Jejunostomy-Associated Small Bowel Necrosis After Elective Esophago-Gastric Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Feeding jejunostomy has increasingly become a standard adjunctive procedure during major esophago-gastric resections. They provide nutritional support during the post-operative period as required. However, significant early complications have been reported, most notably small bowel necrosis. Literature reports have been restricted to case reports or series. This study aims to determine the frequency of this complication in a cohort of patients undergoing esophago-gastric resection, and identify any difference in the risk of this complication between patients undergoing esophagectomy and gastrectomy.

Methods

Consecutive patients who had esophago-gastric resections for malignancy and who had a feeding jejunostomy placed were identified from a prospectively maintained database at Leicester Royal Infirmary during the years 2009–2015. Case notes were reviewed to extract information relating to demographics, presenting features and clinical outcome.

Results

The study included 360 patients, 285 of which had esophagectomy and 75 had gastrectomy. There were no small bowel complications among esophagectomy patients (0%), while six patients who had total gastrectomy developed small bowel ischemia or necrosis (8%), p = 0.05, in spite of an identical feeding regimen. Every patient that developed the complication underwent surgery with five out six having resection of the infarcted segment and double-barrel stoma formation. A 6–8-week period of parenteral nutrition was required before stoma reversal. One patient had leucocytosis on the day of diagnosis. The other five patients showed no derangements in biochemical or clinical parameters in the preceding 48 h. Five of the six patients survived.

Conclusions

Small bowel necrosis and perforation is a life-threatening complication of feeding jejunostomy. In our cohort, it happened exclusively in total gastrectomy patients. Antecedent signs were lacking. The condition requires prompt attention with earlier use of CT scanning and a return to the operating room. The presence of pneumatosis intestinalis on CT scan should prompt surgical intervention that improves survival.

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Authors and Affiliations

  1. Department of Surgery, Leicester Royal Infirmary, Level 6 Balmoral Building, Leicester, LE1 5WW, UK

    Omer S. Al-Taan, Robert N. Williams, James A. Stephenson, Melanie Baker, S. Murthy Nyasavajjala & David J. Bowrey

Authors
  1. Omer S. Al-Taan
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  2. Robert N. Williams
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  3. James A. Stephenson
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  4. Melanie Baker
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  5. S. Murthy Nyasavajjala
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  6. David J. Bowrey
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Contributions

O Al-Taan and D Bowrey designed the study, R Williams and M Nyasavajjala reviewed the data and manuscript. J Stephenson reviewed the patients’ scans while M Baker reviewed the nutritional regimens for the series.

The study was registered and approved by the clinical audit department in Leicester Royal Infirmary, Leicester, UK. The registration reference is 7729.

Corresponding author

Correspondence to Omer S. Al-Taan.

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Declaration

DJ Bowrey has received departmental funding for research work unrelated to this publication from Fresenius-Kabi and Nutricia.

Conflict of Interest

The authors declare that they have no conflict of interest.

Consent to Participate

All study participants, or their legal guardian, provided informed verbal or written consent prior to study enrolment.

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Al-Taan, O.S., Williams, R.N., Stephenson, J.A. et al. Feeding Jejunostomy-Associated Small Bowel Necrosis After Elective Esophago-Gastric Resection. J Gastrointest Surg 21, 1385–1390 (2017). https://doi.org/10.1007/s11605-017-3438-6

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  • DOI: https://doi.org/10.1007/s11605-017-3438-6

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