Small bowel necrosis associated with postoperative jejunal tube feeding.
BACKGROUND
Postoperative enteral nutrition using jejunal tube feeding is widely practiced and usually well tolerated. Functional intestinal complaints occur frequently but generally respond to alteration of the infusion rate or tube feeding formula. Occasionally, however, nonspecific signs of intestinal disturbance progress to a syndrome of abdominal distention, hypotension, and hypovolemic shock resulting in extensive small bowel necrosis.


METHODS
During a six-year period, four patients have been identified retrospectively who had this complication among 1,359 patients receiving jejunal tube feeding. Their clinical course was evaluated critically and compared with 11 cases described in the literature.


RESULTS
Small bowel necrosis is a rare but highly morbid complication associated with postoperative jejunal tube feeding. Of 14 patients who had small bowel necrosis develop, 12 succumbed to this complication. The causative mechanism remains unclear, but is most likely the result of several factors.


CONCLUSIONS
Tube feeding should be discontinued immediately and total parenteral nutrition should be considered in patients who have abdominal pain, abdominal distention, increased nasogastric drainage, and signs of intestinal ileus.
Schunn
C D
CD
Division of Surgical Oncology, University of Pennsylvania School of Medicine, Philadelphia, USA.
Daly
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D007582:Jejunostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011182:Postoperative Care; D011859:Radiography; D012189:Retrospective Studies