Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 May 28:2014:bcr2014204394.
doi: 10.1136/bcr-2014-204394.

Recycling of jejunal effluent to enable enteral nutrition in short bowel syndrome

Stephen McCain  1 , Scott McCain  1 , Andrew Harris  1 , Kevin McCallion  1
Affiliations
Case Reports

Recycling of jejunal effluent to enable enteral nutrition in short bowel syndrome

Stephen McCain et al. BMJ Case Rep. .

Abstract

A 41-year-old woman developed severe abdominal pain, distension and faeculent vomiting. CT of abdomen and pelvis revealed small bowel malrotation with a right paraduodenal hernia. At emergency laparotomy, a right paraduodenal hernia containing jejunum and ileum was identified. She had a viable duodenum with 50 cm of ischaemic proximal jejunum which was exteriorised as an end jejunostomy; 180 cm of infarcted jejunum and ileum was resected. The proximal end of 150 cm of healthy ileum was exteriorised as a closed mucous fistula and 50 cm distally a feeding ileostomy was constructed. On day 5 postoperatively, jejunal effluent began to be recycled via her feeding ileostomy and she never required parenteral nutrition. Despite having only 50 cm of jejunum proximal to her stoma, recycling of effluent enabled her electrolytes to remain normal. She put on weight postoperatively and proceeded to closure of her stomas at 6 months, not requiring laparotomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CT scan of abdomen showing closed-loop obstruction (arrows) of small bowel.
Figure 2
Figure 2
CT scan of abdomen showing portal venous gas.
Figure 3
Figure 3
Ischaemic small bowel seen at the time of surgery.
See this image and copyright information in PMC

References

    1. Khan MA, Lo AY, Vande Maele DM. Paraduodenal hernia. Am Surg 1998;64:1218–22 - PubMed
    1. Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. AJR Am J Roentgenol 2006;186:703–17 - PubMed
    1. Hirasaki S, Koide N, Shima Y, et al. Unusual variant of left paraduodenal hernia herniated into the mesocolic fossa leading to jejunal strangulation. J Gastroenterol 1998;33:734–8 - PubMed
    1. Carbonnel F, Cosnes J, Chevret S, et al. The role of anatomic factors in nutritional autonomy after extensive small bowel resection. J Parenter Enteral Nutr 1996;20:275–80 - PubMed
    1. Nightingale JMD, Lennard-Jones JE, Gertner DJ, et al. Colonic preservation reduces the need for parenteral therapy, increases the incidence of renal stones but does not change the high prevalence of gallstones in patients with a short bowel. Gut 1992;33:1493–7 - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources