ISSN 2398-2977      

Jejunum: jejunoileostomy

pequis

Introduction

  • Resection and anastomosis of the small intestine for lesions affecting the distal jejunum and/or ileum.
  • Can only be performed when sufficient healthy ileum is available.
  • The techniques and procedures for the resection and anastomosis are comparable to those for jejunojejunostomy Jejunum: jejunojejunostomy

Uses

Advantages

  • The intestinal anatomy and physiology are left more intact after this procedure than if a jejunocecostomy Jejunum: jejunocecostomy is used. This maintains the ileocecal valve in the normal position between the small intestine and the cecum, preventing retrograde movement of cecal contents back into the ileum during cecal contractions. It also maintains the more muscular wall of the ileum which is more efficient at emptying into the cecum compared to the relatively thin-walled jejunum.
  • This procedure is quicker to perform than a jejunocecostomy.
  • Comparison of jejunojejunostomy with jejunoileostomy has demonstrated no difference between groups in post-operative survival rates.
  • Comparison between jejunoileostomy and jejunocecostomy procedures has demonstrated a more favorable prognosis, better long-term survival rates, and a lower rate of colic after hospitalization with the former. There is, however, an increased need for repeat celiotomy after jejunoileostomy.

Disadvantages

  • The process of resection and anastomosis are performed in closer proximity to the abdominal incision than for jejunojejunostomy with possible increased risks of contamination.
  • Originally it was thought that a jejunoileostomy would fail because of vascular compromise due to the absence of a collateral arcuate blood supply to the ileum. This is now considered to be a rare situation and not likely to affect the clinical use of the technique.
  • There may be an increased risk of post-operative impaction at the anastomosis due to differences in intestinal wall thickness between the jejunum and ileum and intense handling of the ileum leading to edema in the ileum.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Stewart S, Southwood L L & Aceto H W (2014) Comparison of short- and long-term complications and survival following jejunojejunostomy, jejunoileostomy and jejunocaecostomy in 112 horses: 2005-2010. Equine Vet J 46 (3), 333-338 PubMed.
  • Anderson S L, Blackford J T & Kelmer S G (2012) Clinical evaluation of a closed, one-stage, stapled, functional, end-to-end jejuno-ileal anastomosis in 5 horses. Can Vet J 53 (9), 987-991 PubMed
  • Lee W L et al (2012) In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine. Vet Surg 41 (5), 589-593 PubMed.
  • Rendle D J et al (2005) End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative study. Equine Vet J 37 (4), 356-359 PubMed.
  • Loesch D A et al (2002) Jejunoileal anastomosis following small intestinal resection in horses: seven cases (1999-2001). JAVMA 221 (4), 541-545 PubMed.

Other sources of information

  • Southwood L L (2013) Ed Practical Guide to Equine Colic. Wiley-Blackwell, USA.

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