DOI: http://dx.doi.org/10.18203/2349-2902.isj20210929

Evaluating outcomes in patients of jejunal stoma

Rajkumar Chejara, Rohit Chaudhary, Ashok Sharma, Dheer Singh Kalwaniya, Ankur Garg, Monish Raj M., Vignesh M.

Abstract


Background: In managing patients with intraabdominal emergency such as perforation of bowel due to trauma, intestinal tuberculosis or in patients with mechanical obstruction with strangulation, we are sometimes left with no other option but to constitute a jejunostomy as the patients general condition is very critical or there is intra-abdominal sepsis with high chances of anastomotic leak and eventual mortality. In this article we have evaluated outcomes of jejunal stoma in terms of morbidity and mortality.

Methods: Study conducted in the Department of Surgery, VMMC and Safdarjung Hospital, New Delhi. 25 patients were evaluated in study for a period of 18 months between October 2018 and April 2020. Patient demographics, preoperative diagnosis, treatment strategies, surgical procedures, and the post-operative course were evaluated.

Results: It was observed that the most common pathologies for formation of jejunostomy were trauma and tuberculosis. patients were readmitted, most commonly due to cause being dehydration and dyselectrolytaemia.80% patient had clavien dindo grade 1 pre-operative complications. Mean time for stoma closure was 5.4 weeks. Most common complication after closure of stoma was Surgical site infection i.e.,9 patients (36%). Overall mortality was 2 (8%).

Conclusions: It is concluded from our study that if jejunostomy has to be made due to unavoidable circumstances then the patient requires regular clinical assessment of nutritional parameters and aggressive corrections of any abnormalities and an early closure of stoma. This shows that knowledge of clinical course of patient with jejunostomy can help us to better manage these patients.


Keywords


Complications, Jejunal stoma, Outcomes

Full Text:

PDF

References


Hyland J. The Basics of ostomies.Gastroenterol Nurs. 2002;25:241-4.

Gondal B, Trivedi MC. An overview of ostomies and the high-output ostomy. Hosp Med Clin. 2013;2:542-51.

Nightingale JMD. Management of patients with a short bowel. World J Gastroenterol. 2001;7:741-51.

Mountford CG, Manas DM, Thompson NP. A practical approach to the management of high output stoma. Frontline Gastroenterol. 2014;5:203-7.

Gupta M, Sonar P, Kakodar R, Kumaran V, Mohanka A, Soin A, et al. Small bowel enterocutaneous fistulae: The merits of early surgery. Indian J Surg. 2008;70:303-7.

Shetty V, Teubner A, Morrisom K, Scott NA. Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen. BJS open. 2006,93:1247-50.

Alam MS, Gondal KM, Siddique H, Muhammad Y. Outcome of early closure of temporary stoma. Annals. 2015;21:214-9.

Baker ML, Williams RN, NIghtinale JMD. Causes and management of a high-output stoma. Colorectal Dis. 2010;13:191-7.

Nagar A, Mehrotra S, Yadav A, Mangla V, Lalwani S, Mehta N, et al. Distal bowel re-feeding in patients with proximal jejunostomy. J Gastrointest Surg. 2018;22:1251-7.

Arenas JJ, Rodriguez CL, Abiles J, Rivera R, Navarro PU, Adan NG. Protocol for the detection and nutritional management of high-output stomas. Nutr J. 2015;14:45.