jejunostomy

Jejunostomy is a surgical procedure that creates a direct opening from the skin into the jejunum, the middle section of the small intestine. The stoma can be used for drainage or for placement of a feeding tube into the jejunal lumen. Jejunostomies may be temporary or permanent and can be performed openly, laparoscopically, or by percutaneous endoscopic techniques.

Indications include impaired oral intake or unsafe swallowing (for example due to neurodegenerative disease, head and neck cancer, esophageal or gastric obstruction, or severe gastroparesis). Jejunostomy is chosen when gastric feeding is not tolerated or carries a high risk of aspiration, or when long-term enteral nutrition is required.

Common approaches are surgical jejunostomy (open or laparoscopic), needle catheter jejunostomy, and percutaneous endoscopic jejunostomy (PEJ). A feeding tube (often called a J-tube) or a jejunostomy button is placed through the abdominal wall into the jejunum. PEJ typically uses endoscopic guidance to access the jejunum from the stomach or via direct jejunal entry.

Complications include infection at the stoma, leakage, tube dislodgement or obstruction, and bowel perforation or peritonitis in rare cases. Long-term issues may involve skin irritation, granulation tissue, and tube dysfunction.

Care and management involve regular stoma and tube care, flushing to maintain patency, and monitoring nutrition. Feeding regimens are individualized and often begin with small volumes, increasing gradually as tolerated. Device replacement or adjustment may be needed over time.