Bowel necrosis caused by water in jejunal feeding

BACKGROUND: Fifteen reports of bowel necrosis in patients receiving jejunal feeding have been reported. Etiology remains unexplained. METHODS: A patient with a 60% burn receiving jejunostomy tube feeding developed hypernatremia and was given distilled water in the jejunum, 400 mL every 2 hours. One...

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Bibliographic Details
Published in:JPEN. Journal of parenteral and enteral nutrition 2004-01, Vol.28 (1), p.27-29
Main Authors: Schloerb, PR, Wood, JG, Casillan, AJ, Tawfik, O, Udobi, K
Format: Article
Language:English
Subjects:
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Biological and medical sciences
Burns - therapy
Cell Nucleus - pathology
Cytoplasm - pathology
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Enteral Nutrition - adverse effects
Enterocytes - pathology
Epithelial Cells - pathology
Humans
Intensive care medicine
Intestine, Small - pathology
Intestines - pathology
Jejunostomy
Male
Medical sciences
Microvilli - pathology
Necrosis
Rats
Rats, Sprague-Dawley
Water - adverse effects
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Summary:BACKGROUND: Fifteen reports of bowel necrosis in patients receiving jejunal feeding have been reported. Etiology remains unexplained. METHODS: A patient with a 60% burn receiving jejunostomy tube feeding developed hypernatremia and was given distilled water in the jejunum, 400 mL every 2 hours. One week later, he developed an acute abdomen with abdominal distention. At operation, he had 4 L of cloudy fluid containing jejunal feeding. Three large duodenal perforations were present. The jejunostomy site was normal. In an animal study, water or normal saline (0.85% NaCl) were infused into the mid small bowel, and sections of bowel were taken 5 minutes later for histologic study. RESULTS: Animal study of the effect of water in the rat intestine revealed disruption of intestinal epithelium. It is suggested that disruption of epithelium by electrolyte-free water may permit digestion of the bowel wall and result in perforation, as was observed in this patient. This mechanism may have been responsible for some of the cases reported in the literature. CONCLUSIONS: Tap or distilled water may injure intestinal epithelium and should not be infused directly into the small bowel as jejunal feeding.
ISSN:0148-6071
1941-2444
DOI:10.1177/014860710402800127