Bowel Necrosis Associated With Early Jejunal Tube Feeding

Abstract

HYPOTHESIS: Postoperative enteral nutrition may sometimes be responsible for severe complications such as mesenteri ischemia. DATA SOURCES: Studies in the English literature were identified by a computer-assisted search of the MEDLINE database using the key words "enteral feeding OR jejunostomy" AND "complications OR mesenteric ischemia." Cited references of each retrieved paper were checked for relevance. STUDY SELECTION: All reports of mesenteric ischemia in the setting of postoperative enteral feeding were included. In cases of multiple articles from the same institution with overlapping patients, the most exhaustive article was included. DATA EXTRACTION: All reports were abstracted for number of patients, presence of preoperative comorbidities, development of perioperative hypotension or mesenteric occlusion, and outcome. DATA SYNTHESIS: Nine studies were retrieved in which enteral feedings were responsible for bowel ischemia; we report an additional case. The common clinical picture is that of a patient without significant risk factors for mesenteric ischemia, which during the early postoperative course develops nonspecific abdominal symptoms and then rapidly progresses to septic shock and eventually to multisystem organ failure and death. Mesenteric ischemia may present in up to 3.5% of enterally fed surgical patients; the associated mortality approaches 100%. The lack of specific symptoms requires a high index of suspicion for diagnosis; prompt abdominal exploration and bowel resection are the only chance for survival. CONCLUSIONS: The benefits of enteral nutrition outweigh the likelihood of severe complications; when mesenteric ischemia develops, early diagnosis is challenging and the prognosis is poor.