Bowel necrosis caused by water in jejunal feeding.
BACKGROUND
Fifteen reports of bowel necrosis in patients receiving jejunal feeding have been reported. Etiology remains unexplained.


METHODS
A patient with a 60% burn receiving jejunostomy tube feeding developed hypernatremia and was given distilled water in the jejunum, 400 mL every 2 hours. One week later, he developed an acute abdomen with abdominal distention. At operation, he had 4 L of cloudy fluid containing jejunal feeding. Three large duodenal perforations were present. The jejunostomy site was normal. In an animal study, water or normal saline (0.85% NaCl) were infused into the mid small bowel, and sections of bowel were taken 5 minutes later for histologic study.


RESULTS
Animal study of the effect of water in the rat intestine revealed disruption of intestinal epithelium. It is suggested that disruption of epithelium by electrolyte-free water may permit digestion of the bowel wall and result in perforation, as was observed in this patient. This mechanism may have been responsible for some of the cases reported in the literature.


CONCLUSIONS
Tap or distilled water may injure intestinal epithelium and should not be infused directly into the small bowel as jejunal feeding.
Schloerb
Paul R
PR
Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas 66160, USA. pschloer@kumc.edu
Wood
John G
JG
Casillan
Alfred J
AJ
Tawfik
Ossama
O
Udobi
Kahdi
K
D000328:Adult; D000818:Animals; D002056:Burns / Q000628:therapy; D002467:Cell Nucleus / Q000473:pathology; D003593:Cytoplasm / Q000473:pathology; D004750:Enteral Nutrition / Q000009:adverse effects*; D020895:Enterocytes / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D007422:Intestines / Q000473:pathology*; D007582:Jejunostomy; D008297:Male; D008871:Microvilli / Q000473:pathology; D009336:Necrosis; D051381:Rats; D017207:Rats, Sprague-Dawley; D014867:Water / Q000009:adverse effects*
D014867:Water