Proximal diverting jejunostomy for compromised small bowel

The use of a totally diverting proximal jejunostomy in the surgical therapy of five cases of compromised small bowel is reported. In each case a diverting end-on jejunostomy was constructed 30 to 110 cm beyond the ligament of Treitz. The oversewn distal end of bowel was anchored intraperitoneally at the jejunum, and a tube was introduced into the distal intestine for subsequent radiologic study. In three of five cases small bowel leaks were demonstrated after operation by x-ray examination. The leaks caused no clinical problems. The jejunostomy remained in place for 4 to 13 weeks. The mean daily stoma output ranged from 200 to 2800 ml/day. Fluid and electrolyte losses were replaced and total parenteral nutrition was supplied. No stomal complications occurred. Intestinal continuity was restored when contrast medium passed through the intestine without leak or obstruction. Reanastomosis of the intestinal tract was accomplished with minimal dissection through a small peristomal incision because the distal closed end of the divided bowel had been fixed to the stoma base. Each of the patients recovered gastrointestinal function without further complication and was discharged from the hospital on a general diet. With parenteral nutritional support, a high jejunostomy is well tolerated. Proximal intestinal diversion can salvage an otherwise hopeless situation.