Feeding Jejunostomy

Procedure Snapshot

• Indication: Need for long-term enteral access with intact distal GI tract (e.g., esophageal cancer, pancreatitis).
• Expected duration: ___
• Special instruments: Feeding tube 12–14 Fr, tacking sutures, purse-string suture.

Step Workflow

1. Identify ligament of Treitz; measure 30 cm distal.
2. Choose antimesenteric border of jejunum.
3. Place two seromuscular stay sutures 4 cm apart.
4. Create enterotomy (~5 mm); insert tube 2–3 cm.
5. Tie purse-string and fix bowel to abdominal wall with Witzel tunnel (~5 cm).
6. Mature stoma to skin.

Key Pimp Questions

• Q: Why jejunostomy instead of gastrostomy?
  A: When stomach contraindicated (e.g., gastric resection, reflux risk).
• Q: Complications?
  A: Leak, obstruction, infection, torsion (PMID 29566339).

Critical Anatomy

• Landmarks: Ligament of Treitz, mesenteric vessels.
• Danger zones: Mesenteric bleeding, twist at fixation site.

Informed Consent Highlights

• Risks: Leak __, infection __, obstruction ___.

Post-op Considerations

• Tube use after 24 h if no leak; flush regularly.

References

• Chassin’s, Feeding Access chapter.
• Clinical Scenarios, Upper GI.
• Awad 2018 (PMID 29566339).