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Laparoscopic Direct Feeding Jejunostomy
Case description
A 43-year-old woman with a psychiatric history of depression ingested caustic substances (sodium hypochlorite), resulting in severe esophageal and gastric ulcerations confirmed by esophagogastroduodenoscopy. Laparoscopic direct jejunostomy was performed under general anesthesia. The jejunal loop 30 cm distal to the ligament of Treitz was identified and fixed to the peritoneum with a resorbable suture. A serosal pouch was then created using 3/0 Vicryl, followed by a jejunal enterotomy. A Foley catheter was introduced into the jejunal lumen, and the serosal pouch was tightened around the tube. Finally, cardinal sutures were placed around the enterotomy to secure the jejunal loop to the anterior abdominal wall.
Results: The procedure was completed laparoscopically with minimal operative time and no intraoperative complications. Postoperative recovery was uneventful, with early initiation of enteral feeding, and the patient tolerated nutrition well. The patient had a 2-month postoperative follow-up. An esophagogastroduodenoscopy is programmed in one month.
Conclusion: Laparoscopic direct jejunostomy is a safe, effective, and reproducible alternative to Witzel jejunostomy, particularly suited for patients requiring urgent enteral feeding after caustic ingestion. This technique simplifies laparoscopic feeding jejunostomy.
