Abstract
PurposeThe aim of the current study was to report the surgical outcome and complications of jejunostomy with enteroenterostomy for enteral nutrition (EN) in critically ill trauma patients with prolonged nasogastric (NG) nutrition.MethodsThis cross-sectional study was carried out in a level I trauma center in Shiraz, southern Iran during a one-year period from 2016 to 2017. We included a total number of 30 patients with severe trauma admitted to the intensive care unit (ICU) with more than three months NG nutrition and bowel atrophy. We performed a novel jejunostomy with an enteroenterostomy procedure for providing a route for enteral nutrition in all 30 patients. The rate of complications, such as dislodgement, clogging, obstruction, leakage, mucosal bleeding, and infection, were recorded and reported. We also recorded the hospital and ICU length of stay (LOS).ResultsWe included a total number of 30 patients with a mean age of 35.64 ± 8.91 years, and there were 23 (76.6%) men and seven (23.4%) women among the patients. Overall, 14 (46.6%) patients experienced complications related to the jejunostomy with enteroenterostomy. The most common complication was nausea and vomiting (33.3%) and distention (33.3%), followed by surgical site infection (30.0%). The mean ICU LOS and hospital LOS was found to be 16.8 ± 3.7 and 24.3 ± 4.1 days, respectively. The overall mortality rate was 17 (56.6%), which was secondary to the primary injury and was not related to the procedure.ConclusionJejunostomy with enteroenterostomy is a safe and feasible method for providing a route for EN in critically ill trauma patients with prolonged NG nutrition and bowel atrophy.
Highlights
How to cite this article Paydar S, Moein-Vaziri N, Dehghankhalili M, et al (October 09, 2018) Jejunostomy with Enteroenterostomy for Enteral Nutrition in Critically Ill Trauma Patients
14 (46.6%) patients experienced complications related to the jejunostomy with enteroenterostomy
We provide a novel surgical technique which increases the possibility of jejunostomy tunneling and improves the flow of biliary and pancreas secretions in critically ill trauma patients with prolonged NG nutrition and bowel atrophy
Summary
How to cite this article Paydar S, Moein-Vaziri N, Dehghankhalili M, et al (October 09, 2018) Jejunostomy with Enteroenterostomy for Enteral Nutrition in Critically Ill Trauma Patients. Current guidelines all recommend the early enteral nutrition (EN) in critically ill surgical and trauma patients to reduce the infectious complications and the mortality rate through different mechanisms [1,2,3,4,5]. In source-limited hospitals, early jejunostomy is not applicable, especially in patients with severe traumatic brain injury (TBI), mostly because of ethical issues. In these patients, most of the guardians do not consent for early jejunostomy with a hope of early increased level of consciousness and oral feeding [11]. We usually encounter an atrophic bowel when performing jejunostomy which is, in turn, associated with increased feeding intolerance and a higher incidence of an enterocutaneous fistula after the tube removal [11,12]
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