Small bowel necrosis associated with postoperative enteral feeding

Enteral feeding by jejunostomy is one of the main surgical procedures used to supply the proteins and calories necessary in the early postoperative period after major surgery of the upper digestive tract. The complications associated with early postoperative enteral feeding may vary from signs of gastrointestinal intolerance such as nausea, emesis, diarrhoea and cramp-like abdominal pain to hypotension and hypovolaemic shock, and also to the development of small bowel ischaemia and necrosis. Ischaemic intestinal involvement with progression towards necrosis is fortunately a rare event. The cause is not well known. A multifactorial pathogenesis of the mucosal damage has been proposed, where hyperosmolarity of feeding and bacterial overgrowth, due to excessive fermentation of carbohydrates, a decreased mesenteric blood flow and a lowering of peristalsis have been adduced as causes of mucosal injury. We report a case of intestinal necrosis following a jejunostomy procedure, which led to ileal resection.