|
Back to 2017 Posters
JEJUNOSTOMY FEEDING ASSOCIATED WITH NON-OCCLUSIVE MESENTERIC ISCHEMIA AFTER MAJOR UPPER GATROINTESTINAL SURGERY
David R. Chrastek*, James W. O'Brien, Michael Lewis
Upper GI, Norwich and Norfolk University Hospital, Norwich, United Kingdom
Introduction: The etiology of non-occlusive mesenteric ischemia (NOMI) is debated. It is seen after major surgery on the background of physiological changes in splanchnic perfusion. We present a series of patients who developed NOMI following major upper gastrointestinal (UGI) surgery with feeding jejunostomies.
Methods: Retrospective review of all cases of NOMI associated with major UGI surgery and jejunostomy feeding from 2004 to date were identified.
Results: From 2004 to 2012 a total of 231 patients underwent major UGI surgery with a feeding jejunostomy tube. Of those treated with the old protocol, 6 patients developed NOMI. NOMI occurred at a mean time of 6 days post-operatively. Mean feeding rate prior to NOMI was 43.7ml/hr (Range 0ml - 85ml/hr). NOMI was treated with laparotomy and resection in 5 patients and laparotomy and peritoneal lavage in 1. In all laparotomies the small bowel was noted to have patchy ischemia associated with large volumes of intraluminal enteral feed. Mortality rate at 1 year in patients with NOMI was 33% (2 patients). Following 2012 the in-hospital feeding protocol was changed. Jejunal feeding tubes were used sparingly only in patients with pre-operative sarcopenia and those expected to take longer to eat normally. After the protocol change, a total of 52 patients had major GI surgery with a feeding jejunostomy, resulting in no further cases of NOMI.
Conclusion: In patients with feeding jejunostomies following major UGI operations, NOMI is often likely caused by excessive early feeding. This has been prevented by following a more cautious post-operative feeding protocol in our institution.
Back to 2017 Posters
|
