Is jejunosigmoidostomy a recommended approach for managing intestinal obstruction in a patient at this stage?

Is Jejunosigmoidostomy a Recommended Approach for Managing Intestinal Obstruction?

Jejunosigmoidostomy is NOT a recommended surgical approach for managing intestinal obstruction, and no current guidelines support this specific anastomotic technique. The available evidence focuses on restoring bowel continuity through more standard approaches, and the specific jejunum-to-sigmoid connection lacks supporting data for safety or efficacy in obstruction management.

Why This Procedure Is Not Recommended

Lack of Guideline Support

• No major gastroenterological or surgical guidelines mention jejunosigmoidostomy as a treatment option for intestinal obstruction 1
• The absence of this procedure from comprehensive guidelines on intestinal failure, short bowel syndrome, and malignant obstruction suggests it is not part of standard practice 1

Physiologic Concerns

• Bypassing the ileum eliminates critical absorptive capacity, particularly for vitamin B12, bile salts, and fluid/electrolyte reabsorption 1
• Connecting jejunum directly to sigmoid colon would create massive fluid and electrolyte losses, as jejunal effluent contains approximately 100 mmol/L of sodium and requires the absorptive capacity of the ileum and right colon 1
• Patients would likely develop severe salt and water depletion, hypomagnesemia, and malnutrition similar to or worse than jejunostomy patients 1

What IS Recommended Instead

For Malignant Obstruction

Gastric Outlet Obstruction:

• Surgical gastrojejunostomy (laparoscopic preferred) for patients with life expectancy >2 months, good functional status, and surgical fitness 1
• Enteral stent placement for patients not candidates for surgery 1
• EUS-guided gastroenterostomy as an alternative at experienced centers 1

Colonic Obstruction:

• Self-expanding metal stents (SEMS) as bridge to surgery for resectable disease 1
• SEMS or diverting colostomy for non-resectable disease based on patient goals 1

For Short Bowel Syndrome

The priority is restoring colonic continuity when possible:

• Re-establishing jejunocolic or jejunorectal anastomosis improves hydromineral and energy balance, even with minimal remaining colon (≥30% or rectosigmoid alone) 1
• This approach reduces parenteral nutrition dependence and improves quality of life 1
• The key principle: "better to have a functioning and accessed short gut rather than a longer but nonfunctioning gut" 1

For Chronic Intestinal Dysmotility

In selected severe pseudo-obstruction cases:

• Extensive small bowel resection with jejunocecal (not jejunosigmoid) anastomosis may be considered 1
• This allows unrestricted oral intake, reduces vomiting, and decreases parenteral nutrition dependence 1

Critical Pitfalls to Avoid

• Never bypass functional colon unnecessarily - the colon provides critical water, sodium, and short-chain fatty acid absorption 1
• Avoid creating high-output situations that would require lifelong parenteral support when better alternatives exist 1
• Do not perform novel anastomoses without evidence base - stick to established procedures with known outcomes 1

The Bottom Line

If bowel continuity restoration is needed, standard approaches include jejunocolic, jejunoileal, or ileocolic anastomoses depending on remaining anatomy 1. Jejunosigmoidostomy specifically lacks any supporting evidence and would create severe physiologic derangements by eliminating the ileum and right colon's absorptive capacity 1. For any intestinal obstruction, management should follow established algorithms based on etiology (malignant vs. benign), location, patient functional status, and prognosis 1.