ORIGINAL ARTICLE   Free

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