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Proximal diverting jejunostomy for compromised small bowel.

M W Mulholland, J P Delaney

    Surgery
    |March 1, 1983
    PubMed
    Summary

    A proximal jejunostomy effectively manages compromised small bowel, allowing for diagnosis of leaks and safe restoration of intestinal continuity. This surgical technique aids patient recovery with minimal complications.

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    Area of Science:

    • Gastroenterology
    • Surgical Innovation
    • Abdominal Surgery

    Background:

    • Small bowel compromise presents significant surgical challenges.
    • Effective management strategies are crucial for patient outcomes.
    • Proximal diversion is a potential therapeutic approach.

    Observation:

    • A novel surgical technique utilizing a totally diverting proximal jejunostomy was employed in five patients with compromised small bowel.
    • The jejunostomy was placed 30-100 cm distal to the ligament of Treitz.
    • A distal tube facilitated radiologic assessment of the bowel.

    Findings:

    • Postoperative radiologic studies identified small bowel leaks in three of five cases, which were clinically asymptomatic.
    • Jejunostomy output varied (200-2800 ml/day), managed with fluid/electrolyte replacement and total parenteral nutrition.
    • No stomal complications were observed during the 4-13 week duration of the jejunostomy.

    Implications:

    • Proximal intestinal diversion can salvage compromised small bowel, preventing further complications.
    • Restoration of intestinal continuity was achieved with minimal dissection.
    • This technique, supported by parenteral nutrition, is well-tolerated and facilitates recovery.

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