Successful Management of Salt and Water Depletion for Jejunostomy Patient Using Saline for the Solution of the Elemental Diet: Report of A Case

Tomo Osako, Hiroshi Kounosu, Tsunehisa Yamamoto, Ikuya Fujiwara, Yasunori Sawabe and Shuji Shirakata

Department of Surgery, Ayabe Municipal Hospital

An 81-year-old woman admitted for epigastralgia, and the angiography revealed occulusion of the superior mesenteric artery by thrombus. The operative findings showed massive bowel necrosis. Extensive bowel resection and jejuno-colic anastomosis was performed. The remaining length of the jejunum was 50 cm. Postoperatively a major leakage of the anastomosis occurred, so an end-jejunostomy was performed. Patients with a jejunostomy have major problems with undernutrition, dehydration, and sodium depletion due to the large volume of stomal output. During the replacement of the total parenteral nutrition with enteral nutrition, the reduction of the parenteral saline supply or the increase of the enteral nutrition caused hyponatremia and hypochloremia. Using saline for the solution of the elemental diet, we could replace the parenteral nutrition with the enteral nutrition and peroral nutrition without electrolyte depletion. The elemental diet probably promotes dehydration, however, because of its hyperosmolality. Patients such as ours thus still need a parenteral saline supply.

Key words
short bowel syndrome, jejunostomy, salt and water depletion

Reprint requests
Tomo Osako Department of Breast Oncology, Cancer Institute Hospital
3-10-6 Ariake, Kotou-ku, 135-8550 JAPAN

Accepted
April 27, 2005

To read the PDF file you will need Abobe Reader installed on your computer.