Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.
Enteral Nutrition ; Esophagectomy* ; Humans ; Jejunostomy* ; Nutritional Status

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

Malignant tumors of the small bowel are uncommon by comparison with those in other parts of the gastrointestinal tract. Adenocarcinomas account for about half of the malignant tumors of the small intestine, which account for 1% to 2% of the gastrointestinal neoplasma. Small-bowel tumors are often asymptomatic and without clinical significance, and later became symptomatic and are eventually fatal. Patient's with regional enteritis, especially those who have had segments of the intestine surgically by passed, have an increased incidence of small-bowel cancer. The author experienced a case of an adenocarcinoma at the jejunostomy site (Braun anastomosis) which was treated by using a B II type subtotal gastrectomy for stomach cancer. That case of a jejunostomy site adenocarcinoma is reported and the literature on small-bowel malignancy is reviewed.
Adenocarcinoma* ; Crohn Disease ; Gastrectomy ; Gastrointestinal Tract ; Incidence ; Intestine, Small ; Intestines ; Jejunostomy ; Stomach Neoplasms

We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture).
Aged ; Anti-Bacterial Agents ; Cellulitis* ; Drainage* ; Endoscopy, Digestive System ; Esophagitis* ; Esophagus ; Female ; Humans ; Jejunostomy* ; Suppuration

Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.
Anti-Bacterial Agents ; Humans ; Ileostomy ; Ischemia ; Jejunostomy ; Laparotomy ; Necrosis ; Peritoneal Dialysis ; Peritonitis ; Staphylococcus aureus

Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed.
Anastomosis, Roux-en-Y ; Bacteria ; Bile ; Cholestasis ; Drainage ; Gastropexy ; Jaundice, Obstructive ; Jejunostomy ; Liver ; Pancreaticoduodenectomy ; Sepsis ; Stents

Parkinson's disease is a relatively common neurologic disorder that afflicts approximately 1% of the population over 50 years old. Many drugs currently used for the treatment of Parkinson's disease may interact with anesthetic drugs. Brief interruption of levodopa during surgery may result in exacerbation of Parkinson's symptoms. However, safe and effective way to administer levodopa during surgery are not widely known. We report the perioperative treatment of a patient with Parkinson's disease by using intraoperative administration of levodopa through nasogastric tube and feeding jejunostomy tube. This method of levodopa administration successfully prevented the exacerbation of Parkinsonian symptoms.
Anesthetics ; Humans ; Jejunostomy ; Levodopa* ; Middle Aged ; Nervous System Diseases ; Parkinson Disease*

Sorafenib, an oral multi-kinase inhibitor, is used for the treatment of patients with radioactive iodine (RAI) refractory differentiated thyroid carcinoma (DTC) with favorable outcomes. Some unusual but fatal adverse effects are known for this drug and tracheoesophageal fistula (TEF) is one of them, which has never been reported in thyroid cancer patients. We present a successfully treated patient who had developed TEF associated with rapid tumor regression during sorafenib treatment for locally advanced papillary thyroid carcinoma (PTC). Sorafenib was discontinued and feeding jejunostomy tube was placed for nutritional support. 3 months later, the TEF had successfully healed and there was no visible fistula track or interval change of the viable tumor during 15 months of follow-up. Identifying patients at high risk for this potential complication and paying special attention when prescribing anti-angiogenics to these patients are crucial to prevent associated morbidity and mortality.
Fistula ; Follow-Up Studies ; Humans ; Iodine ; Jejunostomy ; Mortality ; Nutritional Support ; Thyroid Gland* ; Thyroid Neoplasms* ; Tracheoesophageal Fistula*

BACKGROUND & PURPOSE: The most popular anastomotic method for a Billroth-II gastrectomy is an 'Albert-Lembert' type two-layer gastro jejunostomy (G-Jstomy) which seems more secure than a 'Gambee' type single-layer anastomosis which provides better mucosal apposition. Since 1995, I have used linear-type staplers during a Billroth-II gastrectomy and palliative bypass surgery for gastric cancer patients to make the G-Jstomy more convenient. There use shortened the operating time and made the gastrojejunostomy easier. I reviewed four years of stapling experience to prove the merits of a stapled G-Jstomy so as to encourage the surgeons who hesitate to do so for fear of complications. METHODS: 1,049 Billroth-II gastrectomies and 133 palliative gastrojejunostomies were carried out from January 1995 to December 1998 at Asan Medical Center. A linear stapler was used in 319 of the above procedures. RESULTS: A linear stapler with two rows of staples was used without any anastomotic leakage or hemorrhage. However, I experienced several efferent jejunal loop obstructions due to adhesion around the anastomosis at the beginning of the trial. All the adhesions occurred at the suture materials of stapler port which was closed manually. No more obstructions were observed after modifying the location of and the closing method for the stapler port. Nowadays, conventional manual G-Jstomy has been safely replaced with a stapled G-Jstomy. CONCLUSION: This report of a clinical trial offers a safe technique for a stapled G-Jstomy by solving the pitfalls.
Anastomotic Leak ; Chungcheongnam-do ; Gastrectomy ; Gastric Bypass* ; Hemorrhage ; Humans ; Jejunostomy ; Stomach Neoplasms ; Sutures

Enteral feeding is generally accepted in patients who cannot take nutrients orally. Percutaneous endoscopic gastrostomy (PEG) is a major enteral means for the introduction of nutritional solutions. However, jejunal feeding is sometimes employed instead of gastric feeding in cases of post-gastrectomy or repeated aspiration after PEG. The digestion and absorption of nutrients in trans-jejunal feeding might be different from those in trans-gastric feeding. In the present study, we measured the serum concentations of micronutrients and vitamins in the cases of direct percutaneous endoscopic jejunostomy (D-PEJ), compared to those of PEG. The enteral feeding has been continued for more than six months in all the cases. Serum copper and zinc concentration were significantly decreased in the D-PEJ group, whereas no significant difference in the concentrations of iron, selenium, vitamins A, B12 and E was ovserved between the two groups. Anemia and neutropenia were frequently observed in many patients with D-PEJ. These conditions were associated with copper deficiency. Much attention should be paid to copper and zinc deficiency in long-term trans-jejunal feeding.
Upper case dee ; Percutaneous endoscopic jejunostomy [PEJ] ; Percutaneous endoscopic gastrostomy ; Serum ; Feeding