COMPLICATIONS OF LONG-TERM JEJUNOSTOMY IN CHILDREN

The authors reviewed 64 jejunostomies performed in 57 patients. Data w ere collected regarding complications and performance of the catheters . Patient diagnoses were grouped as follows: cystic fibrosis (25), neu rological impairment (14), and miscellaneous other (25). Indications w ere malnutrition (43), inability to feed (17), and gastroesophageal re flux (4), Complications were compared between these groups. The age ra nge was 7 days to 23 years. There were 251 tube changes over 142 years of cumulative site patency, for an average of 1.8 tube changes per ye ar and an average life of 2.2 +/- 2.4 years per site, The longest dura tion was 11.7 years, Four tube changes resulted in intraperitoneal ins ertion (6.2% of changes), The overall complication rate was 37.5%. The major and minor complication rates were 21.9% each. Some patients had more than one complication, Stratification of complications by diagno sis showed that the highest incidence was among the neurologically imp aired children (64%), followed by those with cystic fibrosis (32%) and then others (28%). Sixty-four percent of major and 54% of minor compl ications occurred within the first 6 months. The mortality rate was 4. 7%. Infections requiring intravenous antibiotics occurred in 9.4% of t he sites, at an average site age of 8.7 +/- 7.7 months. Tube dislodgme nt requiring surgical replacement occurred in 9.4% of the patients. Ou r mortality and complication rates compare favorably to those of previ ously reported series, Surgical jejunostomy is a reliable long-term so lution to feeding but is associated with a significant risk of complic ations, especially in neurologically impaired children. The risk is gr eatest in the first 6 months after insertion, then decreases as the si te ''matures.'' Copyright (C) 1996 by W.B. Saunders Company