Failure of a feeding jejunostomy.

A healthy 16-year-old female pedestrian was hit by a motor vehicle. She sustained multiple injuries including severe head injury. She was admitted to hospital unconscious. There was no recovery of neurological function. After a short period of time, a jejunostomy was performed for feeding purposes. The major clinical problem continued to be a feeding difficulty, with profuse diarrhoea occurring. At no stage was it possible to adequately nourish her. Hyperperistalsis was noted whilst in hospital. She died just over three months after admission. Autopsy revealed an emaciated body weighing only 25kg. An upper jejunostomy was still present containing a No. 20 French catheter. The bulb had threaded down the small bowel so that it was situated 25cm proximal to the ileocaecal valve. The small bowel was empty. The cause of death was given as malnutrition due to failure of function of a feeding jejunostomy due to small bowel hyperperistalsis in an individual with diffuse brain trauma. This complication of feeding jejunostomy causing death from malnutrition has not previously been described in the English literature.