Immediate jejunostomy feeding. Its use after major abdominal trauma
E. E. Moore, E. L. Dunn and T. N. Jones
Jejunostomy feedings were used in the immediate postoperative period in
patients with massive abdominal and retroperitoneal injuries. Patients were
selected for early feeding if they had two or more major visceral injuries.
Over a six-month period, 30 such patients were studied: ten had blunt
trauma, 11 had gunshot wounds, and nine had stab injuries. The injuries
included 11 pancreatic, ten small-bowel, six colon, and six major
retroperitoneal vascular injuries. A 16-gauge intracatheter was placed in
the proximal jejunum. The constant infusion of nutritional solution
(Vivonex HN) was begun 18 hours postoperatively, and within 72 hours all
patients were receiving 2,400 calories per day. Feedings were maintained
for an average of eight days. Serum albumin and transferrin levels, total
lymphocyte count, and delayed hypersensitivity were maintained or improved
during jejunal feeding. Patients with pancreatic injuries received
supplemental nutrition without evidence of pancreatic stimulation.
Needle-catheter jejunostomy can provide early, safe nutritional support
after major abdominal trauma. Further investigation is needed to determine
who will benefit from this early feeding.
