Abstract
The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2-year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large-bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully in all patients.
No mortality was associated with feeding tube insertion. One patient developed intestinal obstruction believed to be due to angulation of the bowel caused by the jejunostomy tube; the obstruction resolved after removal of the tube. Another patient exhibited paralytic ileus that necessitated discontinuation of the formula; upon resolution of the ileus, administration of the formula resumed. Five patients (26%) developed diarrhea, and two patients had clogged feeding tubes (one had the tube removed and a new tube was inserted under fluoroscopy). Four patients (21%) had inadvertent removal of their tubes, and all tubes were immediately reinserted. Three patients required home enteral support; one experienced a minor skin irritation at the catheter site that resolved by replacement with a larger feeding tube.
In conclusion, the authors have successfully employed enteral feeding in the hospital setting with low morbidity. They selected jejunostomy feeding tubes rather than gastrostomy tubes for patients requiring prolonged enteral nutrition support because of the reduced risk of aspiration of gastric contents.
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