RETROPERITONEAL JEJUNOSTOMY

Abstract

The classic jejunostomy for enteral feedings has several major complications including intraperitoneal leakage and intestinal obstruction. In some children, severe adhesions from previous surgery makes the finding and isolation of the proximal jejunum both tedious and hazardous.A jejunostomy may be easily placed into the retroperitoneal duodenojejunal flexure without entering the peritoneum. This is accomplished by a flank muscle splitting incision displacing the descending colon anteriorly and the kidney posteriorly. A Broviac catheter with a Dacron cuff is used as the conduit. The catheter is secured to the skin until fibrous adhesions have anchored the Dacron cuff.Four retroperitoneal jejunostomy tubes have been placed. The first tube was inserted with an incomplete Dacron cuff and "accidently" extracted on the day after surgery. The second tube was placed for temporary nutritional support until definitive surgery was performed. The tube was in place for 3 months with the patient gaining 2.4 kg. The third and fourth tubes were placed for permanent nutritional support and have been in for 4 and 2.5 months. The patients have gained 1.3 and 3.0 kg, respectively. Both tubes have been transected through carelessness, but easily repaired using the Broviac repair kit.