Immediate jejunostomy feeding. Its use after major abdominal trauma.

Jejunostomy feedings were used in the immediate postoperative period in patients with massive abdominal and retroperitoneal injuries. Patients were selected for early feeding if they had two or more major visceral injuries. Over a six-month period, 30 such patients were studied: ten had blunt trauma, 11 had gunshot wounds, and nine had stab injuries. The injuries included 11 pancreatic, ten small-bowel, six colon, and six major retroperitoneal vascular injuries. A 16-gauge intracatheter was placed in the proximal jejunum. The constant infusion of nutritional solution (Vivonex HN) was begun 18 hours postoperatively, and within 72 hours all patients were receiving 2,400 calories per day. Feedings were maintained for an average of eight days. Serum albumin and transferrin levels, total lymphocyte count, and delayed hypersensitivity were maintained or improved during jejunal feeding. Patients with pancreatic injuries received supplemental nutrition without evidence of pancreatic stimulation. Needle-catheter jejunostomy can provide early, safe nutritional support after major abdominal trauma. Further investigation is needed to determine who will benefit from this early feeding.