jejunostomies

A jejunostomy is a surgical procedure that creates a stoma from the jejunum to the abdominal wall. It provides access for enteral feeding, drainage, or other therapeutic purposes. A jejunostomy tube, often referred to as a J-tube, is inserted through the abdominal wall into the jejunum and can be used for continuous or intermittent feeding. Jejunostomies can be temporary or permanent, depending on the clinical need.

Indications for jejunostomy include the need for long-term enteral nutrition when the stomach cannot be used or is unsafe for feeding, such as after esophagectomy, gastrectomy, severe gastroesophageal reflux, gastric outlet obstruction, or impaired gastric emptying. They are also used in patients at high risk of aspiration or when alternative feeding routes are not feasible, and in certain cases of fistula management or palliative care.

Techniques vary and include open surgical jejunostomy, laparoscopic jejunostomy, and percutaneous or endoscopic jejunostomy (PEJ). In open or laparoscopic approaches, a loop of jejunum is brought to the abdominal wall, fixed, and a tube is inserted to form a mature stoma. In PEJ, a catheter is placed into the jejunum via the abdominal wall under imaging or endoscopic guidance, often with subsequent advancement of a feeding tube.

Postoperative care involves monitoring the stoma, securing and dressing the site, and regular tube management, including flushing and checking placement. Complications can include infection at the stoma, skin irritation, leakage, tube obstruction or dislodgement, stomal stenosis, granulation tissue, parastomal hernia, fistula formation, and, rarely, peritonitis or bowel injury.

Prognosis and use vary; some jejunostomies are temporary with planned reversal, while others remain a long-term or permanent solution for nutrition support.