A unique case report of jejunoileal bypass reversal with review of the literature

Abstract

Highlights Jejunoileal bypass is a surgery of the past however still affects patients being see by surgeons today.The pathophysiology is complicated and it should be known these patients suffer from chronic kidney disease, liver failure, chronic diarrhea and many vitamin deficiencies.Bypass reverseal can help preserve kidney function but may not reverse damages already done.From our experience, Bypassed bowel incorporation back into enteric tract can produced a immune response causing functional obstruction only relieved by removal of this bowel.

A Protocol for Rehabilitating the Bypassed Limb Prior to Reversal of Jejunoileal Bypass

“…This approach places the jejunostomy on non-atrophic jejunum and allows refeeding of the excluded limb. The refeeding protocol was, however, identical, well-tolerated, and effective in both patients, permitting successful restauration of bowel continuity 4–6 months after jejunostomy, comparable to other reports in the literature [ 3 , 4 ].…”

“…Despite some small series [ 1 – 10 , Supplementary Table ], there is a lack of recommendations how to best implement (re)nutrition before JIB reversal. Previous reports provide no details on progression to half-strength nutrition, and refeeding intolerance of the excluded limb has been reported [ 3 , 4 ]. Here, we propose a refeeding protocol for the excluded limb prior to restauration of bowel continuity that has been successfully applied in two patients undergoing JIB reversal.…”