Patient should be allowed oral diet according to caloric requirement and jejunostomy output (partially digested food along with gastric juice, bile and pancreatic secretions) should be fed through mucous fistula(distal stoma) along with nutrients that are not absorbed in proximal jejunum.

I would go with Muhammad on that. 

Besides, you should consider stoma takedown.

Early, you would go on jejunostomy tube feed using fluidy food plus injecting in all contents effluing through the proximal jejnostomy bag. 3 months are enough to build good nutritional status, akbumin and prealbumin olus electrolytes and Hb should be measured to ensure that. Then go for stoma take down and te-anastomosis.

Hello,

I feel you need to do a number of things;

1).  Long term TPN, the patient is young, and there are lots of successful instances when patients have be maintained on parenteral feeding long term, for example, complete intestinal failure, whilst awaiting definitive treatment, in intestinal failure units.

2). Feed through the distal stoma, this might be technically difficult but you could try passing a fine bore tube through the stoma using an endoscope, a good distance, to reduce reflux of feed back out. Reduce her intestinal secretions with octreotide 150 micrograms tds, give her St. Marks solution orally, and NO hypotonic fluids. I can send you the instructions if you need them. Replace intestinal losses IV and by adding to the TPN. Get the dieitian involved.

3). Early reversal of stoma. I would wait about 20 weeks or longer, and also site a feeding enterostomy at time of Surgery well distally.

If anything else comes to mind I will let you know.

Hope that helps,

Gurpreet Singh Ranger