Management of small bowel volvulus around feeding Roux-en-Y limbs.
BACKGROUND
Patients' inability to take oral nutrition calls for alternative feeding. In selected pediatric patients, traditional feeding tubes are not tolerated and jejunal feeding tubes can be obstructive. One option is a Roux-en-Y feeding limb. Our institution noted complications secondary to small bowel volvulus around this limb. Goals of this study were to review patients who experienced volvulus after Roux-en-Y creation, and to identify factors contributing to this complication.


METHODS
Institutional review board approval was obtained for a retrospective chart review. 25 patients were identified as having a Roux-en-Y jejunal feeding limb. Five developed volvulus. Factors documented included age, time to complication, revision, and outcome.


RESULTS
Average age at limb creation was not statistically significant between those with or without volvulus. Mean time to obstruction was 228 +/- 117 days post-limb creation. Average limb length was 18.7 +/- 7 cm in patients with volvulus, 14 +/- 2.3 cm in patients without. 3 of 5 patients presenting with volvulus were discharged home after revision; two patients died.


CONCLUSIONS
There is no definitive way to prevent small bowel volvulus around Roux-en-Y feeding limbs. No predictors of volvulus were identified. Once revised, no recurrences were observed. While this complication is uncommon, it has potentially catastrophic outcomes requiring early intervention.
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. ganice76@yahoo.com
Janice A
JA
Taylor
Frederick C
FC
Ryckman
D000328:Adult; D000367:Age Factors; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods*; D002675:Child, Preschool; D017809:Fatal Outcome; D006801:Humans; D045822:Intestinal Volvulus / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult