title: Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Use of a loop jejunostomy to protect suture lines in the septic abdomen justifies consideration of this procedure in selected patients.
authors.affiliation: Intestinal Failure Unit, Hope Hospital, Manchester, UK.
authors.forename: V
authors.initials: V
authors.lastname: Shetty
authors.forename: A
authors.initials: A
authors.lastname: Teubner
authors.forename: K
authors.initials: K
authors.lastname: Morrison
authors.forename: N A
authors.initials: NA
authors.lastname: Scott
mesh_terms: D000005:Abdomen / Q000601:surgery; D000038:Abscess / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D007582:Jejunostomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures
chemical_list: D000900:Anti-Bacterial Agents