Limited efficacy of early postoperative jejunal feeding.

Twenty patients underwent placement of a jejunal catheter for early postoperative feeding at the time of upper abdominal operations, and a control group of 11 patients underwent operative procedures of similar magnitude without jejunostomy. Advancement of the rate of feeding to target intake over 6 to 7 days was attempted. Complications from the feeding led to cessation or curtailment of intake in 65 percent of the patients. Specific complications included abdominal pain and distention, diarrhea, and retrograde reflux of the feeding into the stomach. No statistically significant difference in nitrogen balance was demonstrated between the fed and unfed groups, presumably due to the limitations of nutrient delivery or absorption in the fed groups or elevated breath hydrogen excretion in patients with abdominal pain and distention suggests that the nature of the nutrients, particularly complex carbohydrates, is a factor in the development of feeding complications. Caution must be exercised in advancing the rate of postoperative jejunal feeding.

Experience with home parenteral nutrition.

Twenty-nine patients underwent courses of home parenteral nutrition therapy ranging from 1.5 to 52 months (mean 14.5 months). The primary diagnoses responsible for the requirement of home parenteral nutrition were radiation enteritis in seven patients, short bowel syndrome secondary to resection in seven, Crohn's disease in two, malabsorption states in six, and other reasons in seven. Seventeen patients (57 percent) had at least one complication. Nine patients had intravenous catheter complications and nine had metabolic complications. Nine patients have died, 11 have been successfully weaned from home parenteral nutrition, and 9 continue to receive home parenteral nutrition. Home parenteral nutrition is useful in a variety of catastrophic clinical situations, including preparation for subsequent operative therapy, temporary malabsorption, and permanent disability of the gastrointestinal tract. Complications are frequent and may be life-threatening.

Parenteral nutrition during pregnancy. Lack of association with idiopathic preterm labor or preeclampsia.

We reviewed published cases of lipid-containing parenteral nutrition during pregnancy to determine the incidence of idiopathic preterm labor and preeclampsia. Seventy-three reported cases of lipid-containing parenteral nutrition during pregnancy were identified. Idiopathic preterm labor occurred in 2 of 11 (18%) cases that delivered prior to term. Most patients who had preterm delivery while receiving parenteral nutrition had underlying medical conditions and/or coexistent obstetric problems that are associated with preterm delivery. Total parenteral nutrition during pregnancy was not associated with an increased risk of preterm delivery from idiopathic preterm labor. Preeclampsia was not reported in patients receiving lipid-containing parenteral nutrition. The lack of association of preeclampsia in patients receiving parenteral nutrition deserves further study.

Hemangioma of the small intestine: case report and literature review.

One case of small bowel polypoid hemangioma of the jejunum presenting as recurrent gastrointestinal blood loss is reported. The presenting symptoms and diagnostic methods are discussed. The importance of intraoperative enteroscopy in diagnosing and treating this condition is emphasized.