A jejunostomy is a surgical procedure in which a hole is made in the small intestine in order to insert a feeding tube. A patient may be given this operation if he has difficulty maintaining a healthy body weight by consuming food through the mouth. A jejunostomy tube (J-tube) may be used to introduce nutritious liquids and medicines to the body when the stomach is not fit for a feeding tube or in order to drain unwanted gases and liquids from the stomach.
This procedure is typically recommended for patients who have a pancreatic disease, have difficulty emptying the stomach, or have a problem with pulmonary aspiration of gastric contents, which occurs when the stomach contents are inhaled into the lungs. As an alternative to a gastrostomy, in which the feeding tube is inserted into the stomach, a jejunostomy may also be used when the stomach needs to be kept strong for further surgeries. Such cases might include patients with esophageal adenocarcinoma, a cancer of the esophagus.
The procedure is so named because the hole, or stoma, is made in the middle portion of the small intestine, or jejunum. The small intestine is a long tube that makes up part of the lower gastrointestinal tract, through which food moves to be digested. Sitting between the stomach and the large intestine, the small intestine is responsible for continuing to break down food that has already been partially digested in the stomach as well as absorbing the food’s nutrients. The remaining matter is then passed on to the large intestine, where the waste is prepared to be excreted. The jejunum segment of the small intestine is situated between the duodenum, which attaches to the stomach, and the ileum, which connects to the large intestine.
A jejunostomy can either be performed as an open surgery, in which the patient is cut open to fully reveal the targeted tissue, or as a laparoscopic procedure. In a laparoscopic operation, the patient will be anesthetized, and the surgeon will make tiny incisions in the belly through which a laparoscope and tools can be inserted. The laparoscope is an imaging device that allows medical professionals to see a real-time movie of the inside of the body without open surgery.
Once the incisions have been made, the J-tube is pushed through the abdominal wall. If the belly were divided into four boxes, or quadrants, the tube entrance would typically be made in the upper left quadrant. A small incision, usually of about 0.12 inches (3 mm), is then made in the jejunum and the tube is inserted so that its opening is in the lumen of the intestine. The lumen is the open space or canal in the center of the intestine. After removing the instruments and cleaning the incision sites, the patient should be ready to attach a feeding set and begin using the J-tube.
Depending on the reason that the surgery is being performed, the patient may be able to return home and administer food and medicine independently. Nurses or doctors will brief the patient on how to use and maintain the feeding tube based on the particular case at hand. Generally, the tube and the skin around the tube should be cleaned daily with cotton pads or a washcloth and soapy water. The patient should be careful, however, not to get the area too wet when showering or taking a bath for the first four to six weeks. The tube should be flushed out with tepid water every six hours or after every feeding, as well as every time feeding is interrupted.
If the J-tube site requires a dressing, this should also be changed on a daily basis. Patients should tell a healthcare professional if they experience redness, pain, swelling, or cracking of the skin surrounding the tube. The tube should also be secured to the body so as to prevent any pulling on the intestine. If the tube falls out, the opening should be covered with a fresh gauze pad and a medical professional should be notified.