Abstract
Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.
基金项目
国家自然科学基金(82270587)
Jinling Hospital Scientific Research Project(YYZD2021011)
NETL
NSTL
维普
万方数据