equis - Articles
Jejunum: jejunocecostomy
Introduction
- If the majority of the ileum requires resection it is recommended to perform a jejunocecal anastomosis, thereby bypassing the remnants of the ileum. If the oral most aspect of the ileum (1-25 cm) are involved, a jejunoileostomy can be performed.
- Reasons include: the relative inaccessibility of the mid to distal ileum due to its intra-abdominal position during surgery.
Uses
- To re-establish the continuity of the gastrointestinal tract after ileal resection.
Advantages
- Better accessibility.
Disadvantages
- Technically demanding.
- Defects in mesentery must be closed to prevent potential mesenteric strangulation.
- Risks of abdominal contamination.
- Post-operative cecal dysfunction, kinking of jejunum, and/or colic.
- Technically demanding.
- Easier to perform if stapling instruments are used - increased cost.
Technical problems
- Accessibility of distal ileal stump for oversewing.
- Abdominal contamination
- Mesenteric closure.
- Tissue too thick for staple usage; tissue inflamed of friable, so suture holding capabilities are decreased.
Alternative techniques
- End-to-end anastomosis of ileum - jejunoileostomy.
- Incomplete jejunocecal bypass - side-to-side anastomosis and leave normal ileal pathway open, eg ileal muscular hypertrophy Ileum: muscular hypertrophy, etc.
- Equipment/technique: hand suturing or stapling devices.
Time required
Preparation
- See Surgical approaches to abdomen Abdomen: surgical approaches, Exploratory laparotomy Abdomen: laparotomy.
Procedure
- Hand sewn end-to-side or side-to-side anastomosis including mesenteric repair: 30-60 min depending upon competence.
- Side-to-side anastomosis using stapling device: 30-45 min.
Decision taking
Criteria for choosing test
- Same as ileal surgical lesions and criteria for surgical resection.
- Most commonly small intestinal strangulating lesions that involve the ileum:
- Pedunculated lipoma.
- Mesenteric rent.
- Epiploic foramen entrapment.
- Inguinal/scrotal hernia.
- Small intestinal volvulus.
Risk assessment
- Breakdown of anastomosis.
- Viability of ileal stump left in place.
- SIRS.
- Cecal function.
- Acute abdominal diseases risks for anesthesia.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Proudman C J, Edwards G B & Barnes J (2007) Differential survival in horses requiring end-to-end jejunojejunal anastomosis compared to those requiring side-to-side jejunocaecal anastomosis. Equine Vet J 39 (2), 181-185 PubMed.
- Rendle D I, Woodt J L, Summerhays G E, Walmsley J P, Boswell J C & Phillips T J (2005) End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study. Equine Vet J 37 (4), 356-359 PubMed.
- Bladon B M & Hillyer M H (2000) Effect of extensive ileal resection with a large resulting mesenteric defect and stapled ileal stump in horses with a jejunocaecostomy: a comparison with other anastomotic techniques. Equine Vet J Suppl (32), 52-58 PubMed.
- Boswell J C, Schramme M C & Gains M (2000) Jejunojejunal intussusception after an end-to-end jejunojejunal anastamosis in a horse. Equine Vet Educ 2 (6), 395-398 VetMedResource.
- Hanson R R et al (1998) Surgical reduction of ileal impactions in the horse - 28 cases. Vet Surg 27 (6), 555-560 PubMed.
- Freeman D E (1997) Surgery of the small intestine. Vet Clin North Am Equine Pract 13 (2), 261-301 PubMed.
- Beard W L et al (1992) Ileocecal intussusception corrected by resection within the cecum in two horses. JAVMA 200 (12), 1978-1980 PubMed.
- Ford T S (1990) Ileocecal intussusception in horses-26 cases (1981-1988). JAVMA 196 (1), 121-126 PubMed.
- Schumacher J et al (1987) Ileocecocolic intussusception as a sequel to jejunocecostomy in a mare. JAVMA 190 (3), 303-304 PubMed.
Other sources of information
- Rendle D I, Boswell J C, Walmsley J P, Phillips T J & Summerhays G E S (2004)Comparison of End-to-End Jejuno-Ileal and Jejuno-Jejunal Anastomoses. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 193.