Percutaneous jejunostomy

Abstract

Direct percutaneous jejunostomy is considered in patients where percutaneous gastrostomy is not feasible (stomach removed or inaccessible). Percutaneous jejunostomy is more difficult than gastrostomy techniques. Direct jejunostomy is performed under fluoroscopic guidance, using a nasojejunal tube to distend the jejunum. The jejunal loop is punctured using a Cope suture anchor, under ultrasound guidance. Water-soluble contrast material is injected through the needle to document intralumenal position, and an anchor is inserted. With the guide wire in place, the track is dilated and a 10-F pigtail catheter inserted into the proximal jejunum. Fluoroscopy can also be used to aid puncture using dilute contrast material, if used via the nasogastric tube. Antiperistaltic agents can also be used to aid jejunal puncture. The cumulative procedure-related mortality from the three reported series in the literature is 2.4%, with minor complications occurring in 10 to 11%. Although jejunostomy is not performed frequently, this is a feasible procedure for interventional radiology.

Keywords: Percutaneous jejunostomy; jejunal obstruction.

Figure 1

(A) Decompressing percutaneous jejunostomy in a patient with dilation of the afferent loop of a Roux-en-Y anastomosis. Axial CT scan of the upper abdomen shows a dilated small bowel loop in the right upper quadrant. (B) The position of the catheter is confirmed after jejunostomy by injecting contrast material.

Figure 2

(A) Percutaneous jejunostomy in a patient with cancer of the esophagus and stomach. The jejunum is punctured; the correct position of the needle is confirmed by injecting a small amount of contrast material. (B) The guide wire is inserted. (C) The catheter and stylet are inserted. The anchor (arrow) is in place. (D) The catheter is in place.

Figure 3

(A) Percutaneous jejunostomy in a patient with carcinoma of the stomach. Abnormal stomach configuration with narrowing of the lumen and a thickened wall (arrows) at fluoroscopy. A vascular catheter has been passed through the stomach and duodenum into the jejunum. (B) The jejunum has been punctured and a guide wire is introduced into the jejunal lumen after injecting a small amount of contrast material. (C) The catheter, fitted on a stylet, is introduced over the guide wire. Note the position of the anchor (arrow) at the point of entry into the jejunal lumen. (D) The position of the catheter is confirmed with injection of a small amount of contrast material.

Figure 4

(A) Percutaneous jejunostomy in a patient who previously underwent resection of the esophagus with pull-up of the stomach and an esophagogastric anastomosis in the neck. A vascular catheter is passed through the upper digestive tract into the jejunum in the upper left quadrant of the abdomen. (B) The jejunum is punctured and the needle position is confirmed. (C) The guide wire and anchor (arrow) are introduced into the lumen. (D) The catheter has been inserted over the guide wire.

Figure 5

Jejunostomy catheter in situ and sutured to the skin.

Figure 6

(A) Fluoroscopic image of a percutaneously inserted jejunostomy catheter. (B) CT image of a percutaneously inserted jejunostomy catheter.