A new method of intestinal perfusion for the management of chronic renal failure; a preliminary report.

Usefulness of intestinal perfusion in the treatment of uremia is limited by (a) low clearances, (b) atrophy of the perfused mucous membrane, and (c) poor toleration by the patient. A method of intestinal perfusion has been devised which uses most of the small bowel without exclusion from the fecal stream. Two Roux-en-Y anastomoses are made, the proximal 12'' below the ligament of Treitz, the distal 18'' above the ileocecal valve. Perfusion is carried out between the proximal jejunostomy and distal ileostomy, daily. Six litres of fluid are perfused in four hours. The bowel is used for digestion during the remaining 20 hours of the day. Patients have solid bowel movements daily, prior to perfusion. Reflux of intestinal contents, between perfusions, is slight. The method allows maximal diffusion, may prevent bowel atrophy and is well tolerated by the patient. The method is being used, in conjunction with hemodialysis, in treatment of chronic uremia.