Is jejunosigmoidostomy (surgical creation of a connection between the jejunum and sigmoid colon) a good approach for managing intestinal obstruction?

Jejunosigmoidostomy is NOT a recommended surgical approach for intestinal obstruction

Jejunosigmoidostomy (direct anastomosis between jejunum and sigmoid colon) is not supported by current evidence-based guidelines and should be avoided in favor of standard surgical approaches for bowel obstruction management.

Why This Procedure Is Not Recommended

The available high-quality guidelines from the World Journal of Emergency Surgery 1 provide comprehensive algorithms for managing intestinal obstruction but never mention jejunosigmoidostomy as an acceptable surgical option. This absence from major international guidelines is telling—it indicates this is not a recognized standard of care.

Standard Approaches for Small Bowel Obstruction

For small bowel obstruction requiring surgery, the evidence-based options are 1:

• Limited intestinal resection with primary anastomosis when segmental ischemia is present in hemodynamically stable patients 1
• Adhesiolysis (laparoscopic or open) for adhesive small bowel obstruction 1
• Damage control surgery with open abdomen for extended intestinal ischemia or peritonitis in unstable patients 1

Standard Approaches for Large Bowel Obstruction

For sigmoid pathology requiring surgery 1:

• Sigmoid colectomy with primary anastomosis is the preferred approach for sigmoid volvulus, diverticular obstruction, or malignant obstruction in stable patients without perforation 1
• Hartmann procedure (sigmoid resection with end colostomy) for high-risk patients, perforations, or hemodynamic instability 1, 2
• Right hemicolectomy for cecal volvulus 1

Critical Problems with Jejunosigmoidostomy

Creating a direct connection between jejunum and sigmoid colon bypasses the majority of the small bowel and entire right colon, which would result in:

• Severe malabsorption of nutrients, bile salts, and vitamin B12
• Massive fluid and electrolyte losses leading to chronic diarrhea
• Bacterial overgrowth from colonic flora refluxing into small bowel
• Profound malnutrition and quality of life deterioration

When Jejunal Procedures ARE Appropriate

The only jejunal procedures supported by evidence are 3, 4, 5:

• Feeding jejunostomy for nutritional access (not for obstruction treatment) 3, 5
• Jejunojejunostomy as part of Roux-en-Y reconstruction after gastric bypass 1, 4
• Gastrojejunostomy for gastric outlet obstruction palliation 6

Common Pitfall to Avoid

Do not confuse jejunosigmoidostomy with legitimate bypass procedures like gastrojejunostomy (stomach to jejunum for gastric outlet obstruction) 6 or jejunojejunostomy (jejunum to jejunum in bariatric surgery) 1, 4. These are fundamentally different procedures with established roles.

The Correct Surgical Algorithm

For intestinal obstruction requiring surgery 1:

1. Identify the level and cause of obstruction via CT imaging
2. Assess for ischemia/perforation requiring emergent intervention
3. Perform exploratory laparoscopy within 12-24 hours for stable patients with persistent symptoms 1
4. Resect only ischemic segments with primary anastomosis when feasible 1
5. Create temporary diversion (Hartmann) only when anastomosis is unsafe 1, 2