title: Is jejunostomy output nutrient or waste in short bowel syndrome? Experience from six cases.
abstract: OBJECTIVE
  Certain patients who undergo proximal jejunum resection are unable to undergo primary anastomosis and require exteriorization of the proximal jejunum. These patients usually have major problems with short bowel due to the high output of the stoma. The output of a proximal jejunostomy contains abundant amounts of enzymes and electrolytes. Therefore, it is a feasible approach to re-infuse jejunostomy output to regain homeostasis. To evaluate the effects of proximal jejunostomy output reinfusion into the distal small bowel for patients with short bowel syndrome, and to determine whether reinfusion could avoid long-term parenteral nutrition (PN).
  
  
  METHODS
  PN was initiated immediately after surgery. When patients started enteral nutrition, we started the proximal jejunostomy output reinfusion protocol. Proximal jejunostomy output reinfusion was performed by the patients, and continued by them after discharge. When proximal jejunostomy output reinfusion could be performed stably, PN was stopped.
  
  
  RESULTS
  The median length of the proximal jejunum was 20 cm and of the distal small bowel was 77.5 cm in patients who could stably receive proximal jejunostomy output reinfusion alone. Three patients did not require home PN; they only required PN during hospitalization. Four patients successfully underwent stoma takedown with intestinal anastomosis after 6-7 months without any nutritional or metabolic complications.
  
  
  CONCLUSIONS
  Short bowel syndrome patients with an adequate length of small bowel and functional colon could avoid long-term PN by receiving reinfusion of proximal jejunostomy output into the distal small bowel.
authors.affiliation: Department of Nutrition, Tainan Sin-Lau Hospital, Tainan City, Taiwan.|Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Liu
authors.affiliation: Department of Surgery, Tainan Sin-Lau Hospital, Tainan City, Taiwan.
authors.forename: Hsiu-Chih
authors.initials: HC
authors.lastname: Tang
authors.affiliation: Department of Nursing, Tainan Sin-Lau Hospital, Tainan City, Taiwan.
authors.forename: Hui-Lan
authors.initials: HL
authors.lastname: Yang
authors.affiliation: Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan City, Taiwan. Email: sjchang@mail.ncku.edu.tw.
authors.forename: Sue-Joan
authors.initials: SJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D012778:Short Bowel Syndrome / Q000601:surgery*; D016896:Treatment Outcome