Prospective randomised trial of bolus vs. continuous regime of jejunostomy feed

Enteral alimentation can be administered continuously, cyclically, intermittently, or by a bolus technique. Current literature does not suggest superiority of any one regime. Most studies have used nasogastric feeds, little is known about the outcome of jejunal feeding. This study compares the efficiency and safety of bolus and continuous jejunostomy feeding. 46 adults undergoing a feeding jejunostomy for nutritional support or as an adjunct to a major upper GI surgery, were randomised to bolus feeding (BF group, n = 24) and continuous feeding (CF group, n = 22). Demographic, anthropometric, and laboratory parameters were measured preoperatively and on post-operative days (POD) 3, 7, 15, and 30. These parameters; as well as nutritional and functional outcomes, and complications at POD 30; were comparable in both groups. Both groups tolerated jejunal feeds well. Bolus feeding is simple, inexpensive, and permits daily physical activities. Hence it may be preferred over continuous jejunostomy feeding for enteral alimentation.

Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube

Background Several modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results. Methods We compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT). Results A total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12–15] vs. 17 [IQR, 14–22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10–15] vs. 17 [IQR, 13–23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1–3.5] vs. 5 [IQR, 4–6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14–22] vs. 20 [IQR, 17–28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61). Conclusion Jejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.

PENGARUH TERAPI NUTRISI PADA PASIEN POST OPERASI LAPARATOMI EKSPLORASI THREE OSTOMY DECOMPRESSION, JEJUNOSTOMY FEEDING, PERFORASI GASTER, LASERASI DUODENUM PARS IV ET CAUSA TRAUMA TUMPUL ABDOMEN, FISTEL ENTEROKUTAN DAN HIPOALBUMINEMIA

Pendahuluan: Trauma merupakan salah satu penyebab utama kematian di negara maju dan berkembang. Meningkatnya metabolisme pada trauma, menyebabkan pemecahan massa tubuh tanpa lemak, yang dapat berkontribusi pada terjadinya malnutrisi, sehingga diperlukan terapi nutrisi yang adekuat. Laporan Kasus: Kami laporkan laki-laki, berusia 19 tahun dikonsul dari bagian bedah digestif, dengan asupan via parenteral dialami sejak 5 hari lalu karena dipuasakan post operasi. Riwayat demam dan muntah 6 hari lalu. Ada batuk dan sesak. Pemeriksaan fisik didapatkan kesadaran compos mentis, tanda vital dalam batas normal, terpasang NGT dekompresi, O2 via nasal kanul, drain cavum douglasi, gastrostomi dekompresi, serta jejunostomy feeding. Hari ke 10 post operasi ditemukan fistel enterokutan pada luka operasi. Hasil laboratorium didapatkan anemia, leukositosis, hipertrigliserida, hipoalbuminemia, deplesi berat sistem imun serta ketidakseimbangan elektrolit. Status gizi moderate protein energy malnutrition. Terapi nutrisi diberikan secara bertahap sesuai toleransi dengan target 2400 kkal dan protein 1,7-2 gr/kgBBI/hari via parenteral. Pada hari ke 28 perawatan mulai diberikan via oral dan parenteral untuk mencukupi kebutuhan. Selain itu, diberikan suplementasi Cernevit 1 ampul/24 jam/IV dan neurobion 1 ampul/24 jam/IM. Setelah 60 hari perawatan, pasien dapat makan sepenuhnya via oral dan luka fistel menutup. Kesimpulan: Terapi nutrisi yang tepat penting untuk meningkatkan hasil akhir pada pasien.

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

Here we describe an atypical presentation of progressive dysphagia in a 72-year-old man leading to frequent regurgitations over the course of 30 years. Investigations revealed a foreign body ring surrounding the proximal stomach and dilation of the oesophagus proximal to the gastro-oesophageal junction. An Angelchik device was extracted; however, the patient’s rapid deterioration prior to surgery, in addition to his severely dysfunctional oesophagus, required placement of a jejunostomy feeding tube. Device removal was complicated by prior abdominal surgery, necessitating a thoracic approach. This case offers guidance on the management of patients with Angelchik prostheses who develop similar complications, while drawing attention to the importance and difficulties of early, definitive diagnosis in oesophageal pathology such as achalasia and gastro-oesophageal reflux disease.

Necrosis of Anterior Wall of Stomach Presenting as Pneumoperitoneum in Neonates- Report of Two Cases with Review of Literature

Necrotising enterocolitis is a common disease that leads to low birth weight and preterm babies. Mostly small intestine and large intestine develop necrosis sparing stomach and duodenum. Necrosis involving the anterior wall of stomach and sparing other parts of Gastrointestinal (GI) tract is a rare entity, but can present in neonates with massive pneumoperitoneum. Though the exact aetiology is not known, it may be related to perinatal hypoxia. Case report of two preterm low birth weight babies who presented with pneumoperitoneum on day three of life had an area of anterior gastric wall necrosis with perforation peritonitis. The rest of GI tract was healthy. After excision of necrotic tissue, suture repair of viable stomach and feeding jejunostomy was done in both cases. These two neonates survived with intensive neonatal ICU care and gradual jejunostomy feeding. Gastric wall necrosis with perforation peritonitis is a rare entity in neonates with high mortality. Tip of nasogastric tube lying outside stomach shadow can give clue to the diagnosis. Survival can be improved by early surgery, good neonatal Intensive Care Unit (ICU) care and gradual jejunostomy feeding.