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Jejunum: jejunoileostomy
Introduction
- Resection and anastomosis of the small intestine for lesions affecting the distal jejunum and/or ileum.
- Can only be performed when sufficient healthy ileum is available.
- The techniques and procedures for the resection and anastomosis are comparable to those for jejunojejunostomy Jejunum: jejunojejunostomy.
Uses
Advantages
- The intestinal anatomy and physiology are left more intact after this procedure than if a jejunocecostomy Jejunum: jejunocecostomy is used. This maintains the ileocecal valve in the normal position between the small intestine and the cecum, preventing retrograde movement of cecal contents back into the ileum during cecal contractions. It also maintains the more muscular wall of the ileum which is more efficient at emptying into the cecum compared to the relatively thin-walled jejunum.
- This procedure is quicker to perform than a jejunocecostomy.
- Comparison of jejunojejunostomy with jejunoileostomy has demonstrated no difference between groups in post-operative survival rates.
- Comparison between jejunoileostomy and jejunocecostomy procedures has demonstrated a more favorable prognosis, better long-term survival rates, and a lower rate of colic after hospitalization with the former. There is, however, an increased need for repeat celiotomy after jejunoileostomy.
Disadvantages
- The process of resection and anastomosis are performed in closer proximity to the abdominal incision than for jejunojejunostomy with possible increased risks of contamination.
- Originally it was thought that a jejunoileostomy would fail because of vascular compromise due to the absence of a collateral arcuate blood supply to the ileum. This is now considered to be a rare situation and not likely to affect the clinical use of the technique.
- There may be an increased risk of post-operative impaction at the anastomosis due to differences in intestinal wall thickness between the jejunum and ileum and intense handling of the ileum leading to edema in the ileum.
Technical problems
- Increased risks of contamination mean that there should be careful draping and packing-off of the surgical site.
- Increased risk of post-operative reflux which may be linked to a reduction in lumen diameter if an inverting suture pattern is used.
- The security of the closure with staples can be affected by tissue thickness.
Alternative techniques
- Jejunocecostomy Jejunum: jejunocecostomy; this is essential if there is not viable ileum to perform the jejunoileostomy.
- Ileoileostomy is used if there is only a short segment of the ileum to be removed, both ends of the ileum can be exteriorized, and the ileal vasculature is intact; this is rarely possible.
Time required
Preparation
- See Abdomen: surgical approaches and Abdomen: laparotomy.
- General anesthesia induction Anesthesia: induction - overview and maintenance Anesthesia: maintenance - overview: 20 min.
- Aseptic preparation: 10 min.
- Ventral midline laparotomy and exploratory and decompression: 30-45 min.
Procedure
- Resection and end-to-end anastomosis - hand sewn: 30-60 min.
- Resection and end-to-end anastomosis - stapled: 20-30 min.
Decision taking
Criteria for choosing jejunoileostomy
- Most commonly small intestinal strangulating lesions that involve the distal jejunum/proximal ileum:
- Pedunculated lipoma.
- Mesenteric rent.
- Epiploic foramen entrapment.
- Small intestinal volvulus.
- Adhesion formation.
Risk assessment
- General anesthesia Anesthesia: general - overview in acute abdominal crisis.
- Tissue health.
- Amount of affected small intestine.
- Viability of intestine left in place.
- Systemic inflammatory response syndrome (SIRS) Systemic inflammatory response syndrome.
- Pre- and intra-operative systemic health and tissue perfusion.
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.
- Stewart S, Southwood L L & Aceto H W (2014) Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010. Equine Vet J 46 (3), 333-338 PubMed.
- Anderson S L, Blackford J T & Kelmer S G (2012) Clinical evaluation of a closed, one-stage, stapled, functional, end-to-end jejuno-ileal anastomosis in 5 horses. Can Vet J 53 (9), 987-991 PubMed.
- Lee W L et al (2012) In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine. Vet Surg 41 (5), 589-593 PubMed.
- Rendle D J et al (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.
- Loesch D A et al (2002) Jejunoileal anastomosis following small intestinal resection in horses: seven cases (1999-2001). JAVMA 221 (4), 541-545 PubMed.
Other sources of information
- Southwood L L (2013) Ed Practical Guide to Equine Colic. Wiley-Blackwell, USA.