Gastrointestinal symptoms attributed to jejunostomy feeding after major abdominal trauma—A critical analysis

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Abstract
Meeting the increased metabolic demands in the critically injured is a continuing challenge. Benefits of early enteral feeding after abdominal trauma have been previously reported, but the frequency of patient intolerance due to GI complaints remains unclear. One hundred twenty-three patients undergoing emergent laparotomy for major abdominal trauma with an abdominal trauma index ≤15 were prospectively randomized to either a control group (n = 52, no enteral nutrition during the first 5 days) or an enteral-fed group (n = 71). The enteral group had a needle catheter jejunostomy (NCI) placed at laparotomy and an elemental diet begun 12 h postoperatively, advanced in volume and concentration at 8-h intervals to 100–125 ml/h of full-strength diet. Symptoms of GI complaints (nausea, vomiting, cramping, distention, and diarrhea) were monitored daily and graded as minimal, moderate, or significant. Fifty percent of the control group had one or more GI complaints during the study period; six (12%) developed moderate discomfort. In the enteral group, 59 (83%) patients reported some GI discomfort; 11 had significant complaints (two nausea, seven cramping, six distention, two diarrhea). Nine (13%) of the enteral-fed patients ultimately required total parenteral nutrition supplementation due to GI complaints. The remaining 62 (87%) enteral patients were maintained on the elemental diet for a mean of 7 days (range 5 to 20). By postoperative day 5, patients received an average of 35 kcal/kg and 14.5 g N/day; 66% (41/62) were in positive N balance. Despite a high frequency of GI symptoms, with daily monitoring, adherence to a feeding schedule, and reassurance by the nutrition staff, the vast majority of patients sustaining major abdominal trauma tolerate full-scale NCJ feedings in the early postoperative period.