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Minerva Chirurgica 2019 April;74(2):121-5

DOI: 10.23736/S0026-4733.18.07714-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Modified Paul-Mikulicz jejunostomy in frail geriatric patients undergoing emergency small bowel resection

Paolo RUSCELLI 1, Georgi POPIVANOV 2, Renata TABOLA 3, Andrea POLISTENA 4, Alessandro SANGUINETTI 4, Nicola AVENIA 4, Claudio RENZI 5, Roberto CIROCCHI 5 , Pietro URSI 6, Abe FINGERHUT 7

1 Unit of Emergency Surgery, Torrette Hospital, Faculty of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy; 2 Military Medical Academy-Sofia, Clinic of Endoscopic, Endocrine Surgery and Coloproctology, Sofia, Bulgaria; 3 Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland; 4 Unit of General Surgery and Surgical Specialties, University of Perugia, Terni, Italy; 5 Department of Surgery and Biochemical Sciences, University of Perugia, Terni, Italy; 6 Department of General Surgery and Surgical Specialties, Sapienza University, Rome, Italy; 7 Section for Surgical Research, Medical University of Graz, Graz, Austria



BACKGROUND: Proximal or extended bowel resections are sometimes necessary during emergency surgery of the small bowel and call for creating a high small bowel stomy as a part of damage control surgery. Secondary restoration of intestinal continuity in the frail geriatric patient, further weakened by subsequent severe malabsorption may be prohibitive.
METHODS: Six patients underwent emergency small bowel resection for proximal jejunal disease (83.3% high-grade adhesive SBO and 16.7% jejunal diverticulitis complicated with perforation). With the intention to avoid end jejunostomy and the need for repeat laparotomy for bowel continuity restoration we modified the classic Paul-Mikulicz jejunostomy.
RESULTS: The postoperative course was uneventful in four patients whose general condition improved considerably. At six-month follow-up, neither patients required parenteral nutrition.
CONCLUSIONS: This modified stoma can have the advantage of allowing a partial passage of the enteric contents, reducing the degree of malabsorption, and rendering jejunostomy reversal easy to perform later.


KEY WORDS: Jejunostomy - Short bowel syndrome - Malabsorption syndromes

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