Journal of pediatric surgery · 2025
Intestinal Dysmotility and the Risk of Volvulus Following Omega-Jejunostomy Tube Placement in Children.
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Scheese Daniel J, Chidiac Charbel, Tragesser Cody, Hodgman Erica I, Cappiello Clint D, Rhee Daniel S, Alaish Samuel M
Аннотация
INTRODUCTION: Gastric dysmotility complicates enteral feeding in children, often requiring distal feeding access. While nasoduodenal and gastrojejunostomy tubes are common, frequent dislodgements necessitate hospital visits for fluoroscopic-guided replacement, exposing children to radiation and potential anesthesia risks. The omega-jejunostomy (OJ) tube was developed as a simpler alternative to roux-en-Y feeding jejunostomy, allowing easy at-home tube changes after tract maturation. Despite nearly two decades of use, OJ-tube placement remains poorly characterized. This study examines patient factors and outcomes following OJ-tube placement in children at a single center.
METHODS: A retrospective review was conducted on 23 pediatric patients who underwent OJ-tube placement at an academic children's hospital (2016-2024). We analyzed demographic, perioperative, and outcome data, including volvulus incidence, reoperations, emergency department (ED) visits, and readmissions.
RESULTS: Intestinal volvulus occurred in 17.4 % (n = 4), requiring emergent laparotomy. Patients with volvulus had longer hospital stays (12.0 vs. 3.5 days, p = 0.02) and higher 30-day readmission rates (100 % vs. 15.8 %, p = 0.004). Intestinal dysmotility was present in 75 % of volvulus cases, suggesting a predisposition (p = 0.07). ED visits occurred in 73.9 % of patients, primarily due to clogged (35.3 %) or dislodged tubes (29.4 %).
DISCUSSION: OJ-tube placement is an effective feeding option but carries risks, including volvulus and frequent ED visits. Intestinal dysmotility may predispose patients to volvulus, warranting careful patient selection and monitoring. Improved caregiver education and mechanical complication management may reduce ED utilization. Further multicenter research is needed to assess volvulus risk in this population.
TYPE OF STUDY: Retrospective Cohort Study.
LEVEL OF EVIDENCE: III.
METHODS: A retrospective review was conducted on 23 pediatric patients who underwent OJ-tube placement at an academic children's hospital (2016-2024). We analyzed demographic, perioperative, and outcome data, including volvulus incidence, reoperations, emergency department (ED) visits, and readmissions.
RESULTS: Intestinal volvulus occurred in 17.4 % (n = 4), requiring emergent laparotomy. Patients with volvulus had longer hospital stays (12.0 vs. 3.5 days, p = 0.02) and higher 30-day readmission rates (100 % vs. 15.8 %, p = 0.004). Intestinal dysmotility was present in 75 % of volvulus cases, suggesting a predisposition (p = 0.07). ED visits occurred in 73.9 % of patients, primarily due to clogged (35.3 %) or dislodged tubes (29.4 %).
DISCUSSION: OJ-tube placement is an effective feeding option but carries risks, including volvulus and frequent ED visits. Intestinal dysmotility may predispose patients to volvulus, warranting careful patient selection and monitoring. Improved caregiver education and mechanical complication management may reduce ED utilization. Further multicenter research is needed to assess volvulus risk in this population.
TYPE OF STUDY: Retrospective Cohort Study.
LEVEL OF EVIDENCE: III.