Small bowel ischemia: a consequence of feeding jejunostomy?

Continuous jejunal feeding through needle catheter jejunostomy is generally well tolerated with minimal morbidity. Small bowel ischemia or infarction has not been reported in association with jejunal feedings. We describe five patients, each of whom had grossly normal small bowel at the time of insertion of needle catheter jejunostomy. All had episodes of hypotension during continuous jejunal feedings, and subsequently had abdominal distention. Upon abdominal exploration, two patients were found to have infarction of the jejunum and three had infarction of the entire small bowel. No evidence of major vascular occlusion or mechanical obstruction was found. Patients at high risk for hypoperfusion may not tolerate jejunal feedings during such episodes. It appears possible that feeding may increase the susceptibility of the gut to hypoperfusion.