Small bowel necrosis in association with jejunostomy tube feedings

Nutritional support is thought to be an important adjunct for minimizing perioperative morbidity. For a variety of reasons, it is now felt that nutrition delivered by the enteral route is preferred over that given parenterally. Although delivery of nutrients into the small intestine, either via a nasoduodenal tube or a surgically placed jejunostomy, is effectively tolerated by most patients, morbid complications are being described with increased frequency. Herein, we describe two patients who underwent major intra-abdominal surgery, one for a malignancy, the other for trauma management. Immediate postoperative feedings were instituted through a surgically placed jejunostomy tube. Several days later, each patient underwent emergency reoperation for clinical findings of an intra-abdominal catastrophe. In both patients, small intestinal infarction in juxtaposition to the site of the tube feedings was found. This experience suggests that the enteral feedings were causally related to this morbid complication, which proved fatal in one patient.