Gastrojejunostomy in Cats

Gastrojejunostomy is a surgical procedure performed by your veterinarian to connect your cat's stomach to the jejunum, which is the proximal loop of your cat’s small intestine. This is performed when a gastric blockage occurs or when the connection from your cat's stomach to their small intestine is compromised as when a gastronomy removing a portion of the stomach is performed and a new route for gastric contents to pass to the small intestine is required. Where a cancerous tumor is present requiring affected tissue be removed, or the upper portion, the duodenum, of the small intestine is compromised, a connection to the more central portion of the small intestine, the jejunum may be preferred. If necessary, the stomach may be bypassed altogether and a percutaneous gastrojejunostomy performed where a tube is inserted into the jejunum through the abdominal wall for direct feeding of the animal.

The requirement for this procedure may be ascertained during exploratory surgery of your pet's abdominal cavity to ascertain the cause of gastrointestinal distress, or as a result of endoscopy where a tube with a camera and light is passed into the digestive system through the esophagus to view the gastrointestinal structures and any disorders that exist.

If gastrojejunostomy is required, your cat may be given antibiotics prior to surgery and will be administered intravenous fluids during and after the procedure. Your cat will be required to fast several hours before surgery. Prior to surgery a physical examination will be performed to ensure your cat is a good candidate for surgery. A sedative, intravenous anesthetic, and gaseous anesthetic will be administered. Your cat’s abdomen will be shaved and cleaned antiseptically. 

An incision will be made in your cat's abdomen. If a gastrectomy is being performed a portion of the stomach will be removed. Gastric veins and arteries will be tied off as well as blood supply to the jejunum. Diseased tissue and tumors are removed as required. Tumors and surrounding tissue will be sent for analysis to ensure appropriate margins exist in the tissue surrounding the removed growth. An incision will then be made in the remaining stomach and jejunum and a connection with a jejunal tube, stoma or anastomosis established, and suturing or stapling placed as appropriate to secure the connection between the stomach and the jejunum. Before closing the abdominal cavity, the anastomosis will be observed to ensure leakage and hemorrhage is not occurring. 

If a percutaneous gastrojejunostomy is required, an incision will be made through the abdominal wall and a jejunostomy tube placed through the incision into the jejunum to provide direct access to the small intestine for temporary feeding of a critically ill animal. 

Postoperative hospitalization for 24 to 48 hours is required for veterinary observation and provision of supportive care through the administration of intravenous fluids, painkillers and antibiotics.

Gastrojejunostomy is the preferred method of surgical procedure when damage or disease to the duodenum makes routing to this section of the intestine not feasible, or when cancerous gastric tumors are removed with a gastronomy. Bypassing the duodenum and removal of additional tissue creates larger healthy tissue margins and decreases the risk of the gastric tumor recurrence at the anastomosis site. Gastrojejunostomy however, is more invasive than gastroduodenostomy, and involves the circumvention of natural tissue and associated biliary systems that can result in more complications post-surgery. 

Post-operatively, cage rest, an E-collar to prevent interference with the abdominal incision, painkillers, antibiotics, and IV fluids will be required. Medication prescribed by your veterinarian should be administered after hospitalization as instructed. Your cat should be kept inside and have limited activity for at least two weeks after surgery. A modified diet to reduce gastrointestinal distress will be recommended by your veterinarian. Monitor your pet's surgical incision for signs of bleeding or infection. Food intake and elimination a well as signs of lethargy, fever, or illness should be monitored and any concerns addressed with your veterinarian immediately. Your veterinarian will schedule a follow-up appointment to remove sutures or staples as necessary and examine your cat post-operatively.

Depending on the cost of living in your area and the extent of medical intervention required by your cat, this procedure and associated costs will range from $1,000 to $3,000. Treatment for cancer postoperatively will require additional expense.

Risk of aspiration with general anesthesia, peritonitis, or other surgical infection and hemorrhaging exists with this surgical procedure but can be mitigated by an experienced surgical team and ensuring your cat is in adequate medical condition prior to undergoing surgery.

Specific risks associated with gastrojejunostomy in cats are:

• Malnutrition or weight loss due to bypassing the duodenum and biliary system
• Abdominal pain and gastrointestinal symptoms after a meal (dumping syndrome)

Discuss these concerns with your veterinarian and what means can be taken to address these conditions if they occur.

Address any gastrointestinal concerns you observe in your cat with your veterinarian so intervention and medical treatment can be established at an early stage. Ensuring your cat has a healthy, appropriate diet and exercise will reduce the incidence of your pet requiring gastrointestinal surgery.