Abstract：
Ostomy/Stoma is a common entity in patients operated for small bowel perforation in developing countries. Delay in presentation, poor general condition, malnutrition and lack of health infrastructure in peripheral areas are some of the causes leading to severe sepsis at presentation. Exteriorising the perforation site as stoma/ostomy is the preferred salvage procedure. Proximal stoma/ostomy is high output and cause fluid and electrolyte imbalance. Also it is difficult to maintain nutrition with oral feeds, as partially digested food along with digestive enzymes gets lost through the stoma. Parenteral nutrition (PN) is widely used in these patients, which is expensive requires hospitalisation, also not without risks e.g. liver dysfunction and associated with complications of central line insertion.
We hereby report our experience of managing three patients of high output jejunostomy with distal enteral feeding provided by feeding chyme and partially digested food into the distal stoma.
After confirming the distal patency of the bowel, we started feeding through distal lumen of stoma (known as distal enteral feeding) in our 3 patients with jejunostomies immediately in postoperative period along with PN. After few days we started decreasing PN, we gradually switched to complete enteral nutrition; and increasing distal feeding and then totally stopping the PN in few days only. We kept a watch on the different parameters of the patient like calories and protein intake, weight, electrolytes, liver function, etc. RESULTS: Distal enteral feeding improved their body weight, maintained their serum electrolytes and liver function tests including serum albumin. After achieving the good nutritional status, we were able to do successful surgical closure of stomas in all the three patients.
In our experience, patients with high-output stomas can be nutritionally maintained with distal enteral feeding without the need of long term PN. Use of distal enteral feeding, if used appropriately and with proper monitoring, can nutritionally build up the patient avoiding the complications of PN.
We hereby report our experience of managing three patients of high output jejunostomy with distal enteral feeding provided by feeding chyme and partially digested food into the distal stoma.
After confirming the distal patency of the bowel, we started feeding through distal lumen of stoma (known as distal enteral feeding) in our 3 patients with jejunostomies immediately in postoperative period along with PN. After few days we started decreasing PN, we gradually switched to complete enteral nutrition; and increasing distal feeding and then totally stopping the PN in few days only. We kept a watch on the different parameters of the patient like calories and protein intake, weight, electrolytes, liver function, etc. RESULTS: Distal enteral feeding improved their body weight, maintained their serum electrolytes and liver function tests including serum albumin. After achieving the good nutritional status, we were able to do successful surgical closure of stomas in all the three patients.
In our experience, patients with high-output stomas can be nutritionally maintained with distal enteral feeding without the need of long term PN. Use of distal enteral feeding, if used appropriately and with proper monitoring, can nutritionally build up the patient avoiding the complications of PN.
摘要：
背景：造口术/造口术是发展中国家小肠穿孔手术患者的常见实体。演示延迟，一般情况差，周边地区营养不良和缺乏卫生基础设施是导致出现严重脓毒症的一些原因.将穿孔部位外化为造口/造口术是首选的抢救程序。近端造口/造口术产量高，导致液体和电解质失衡。用口服饲料也很难保持营养，部分消化的食物和消化酶通过气孔丢失。肠外营养（PN）在这些患者中广泛使用，昂贵的费用需要住院治疗，也不是没有风险，例如肝功能障碍和与中心线插入并发症相关。
目的：我们在此报告我们的经验，通过将食糜和部分消化的食物送入远端造口来管理三名高产量空肠造口术患者的远端肠内喂养。
方法：在确认肠远端通畅后，我们的3例空肠造口术患者在术后立即与PN一起开始通过造口远端腔喂养（称为远端肠内喂养）。几天后，我们开始降低PN，我们逐渐转向完成肠内营养；增加远端喂养，然后仅在几天内完全停止PN。我们密切关注患者的不同参数，如卡路里和蛋白质摄入量，体重,电解质，肝功能,等。结果：远端肠内喂养改善了他们的体重，维持他们的血清电解质和肝功能检查，包括血清白蛋白。在达到良好的营养状况后，我们能够成功地手术关闭所有三名患者的造口。
结论：根据我们的经验，高输出造口患者可以通过远端肠内喂养进行营养维持，而无需长期PN。使用远端肠内喂养，如果使用得当，并进行适当的监测，可以在营养上建立患者，避免PN的并发症。
目的：我们在此报告我们的经验，通过将食糜和部分消化的食物送入远端造口来管理三名高产量空肠造口术患者的远端肠内喂养。
方法：在确认肠远端通畅后，我们的3例空肠造口术患者在术后立即与PN一起开始通过造口远端腔喂养（称为远端肠内喂养）。几天后，我们开始降低PN，我们逐渐转向完成肠内营养；增加远端喂养，然后仅在几天内完全停止PN。我们密切关注患者的不同参数，如卡路里和蛋白质摄入量，体重,电解质，肝功能,等。结果：远端肠内喂养改善了他们的体重，维持他们的血清电解质和肝功能检查，包括血清白蛋白。在达到良好的营养状况后，我们能够成功地手术关闭所有三名患者的造口。
结论：根据我们的经验，高输出造口患者可以通过远端肠内喂养进行营养维持，而无需长期PN。使用远端肠内喂养，如果使用得当，并进行适当的监测，可以在营养上建立患者，避免PN的并发症。
