The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen. BJS 2006; 93: 1247-1250.

Published: 24th July 2006

Authors: V. Shetty, A. Teubner, K. Morrison, N. A. Scott

Background

Bowel repair in the septic abdomen can be problematic. This study investigated the use of a proximal loop jejunostomy to protect injured or fistulated bowel that had been returned to the abdomen after repair and/or anastomosis.

Method

Ten patients who underwent laparotomy for intra‐abdominal sepsis and/or fistulation, followed by distal enteric repair and/or anastomosis and construction of a proximal defunctioning loop jejunostomy, were studied retrospectively. Seven patients had 21 intestinal suture lines returned to the peritoneal cavity in the presence of intra‐abdominal sepsis (14 anastomoses, two enterotomy closures and five serotomy repairs). Two patients had a difficult relaparotomy for pelvic abscess (two distal anastomoses, one enterotomy closure and three serotomy repairs). The final patient had pelvic sepsis and radiation enteritis; the distal anastomosis was defunctioned by a loop jejunostomy.

Results

The median distance from the duodenojejunal flexure to the loop stoma was 80 (range 30–170) cm. All jejunostomies were closed via a local approach, a median of 11 (range 9–18) months after formation. There was no significant postoperative morbidity and no postoperative death. At a median follow‐up of 7 (range 0·5–56) months eight patients had no requirement for nutritional support.

Conclusion

Use of a loop jejunostomy to protect suture lines in the septic abdomen justifies consideration of this procedure in selected patients. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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