Nasogastric Decompression Tube Research Articles

Strangulated Umbilical Hernia: A Case Report

Background: The abdominal wall hernia repair was one of the most frequently performed operations by general surgeons worldwide. The second most common hernia operation is repairs of umbilical hernia. It is estimated that 5% of individuals will develop an abdominal wall hernia over their lifetime. This study aimed to present a case of strangulated umbilical hernia.
 Case presentation: 51 years old male patient presented with sharp, non-radiating pain in the left abdominal region, obstipation, and noted bulge at his umbilicus about one year ago that did not shrink when he was lying down two days ago, the diameter about 7 cm. A plain Abdominal X-ray showed partial small bowel obstruction. The patient was taken to the operation theatre for laparotomy resection and reanastomose ileum and repair hernia defect with mesh. Prior to surgery, the patient received antibiotic therapy with Cefazolin 2gr intravenous, and the nasogastric decompression tube (NGT) was installed. On exploration, it was found necrotic ileum along 15 cm and performed resection, followed by end-to-end anastomosis. After the surgical procedure, the patient's hemodynamics was stable.
 Conclusion: Overall mortality and prognosis of hernia are influenced by whether the surgery was emergent or elective. Mortality is increased to up to 3% with emergency surgery for strangulated bowel, notably when bowel resection is performed.

Strategy to small intestine obstruction caused by Crohn’s disease on the basis of transnasal ileus tube insertion

BackgroundPrevious studies reported that transnasal ileus tube was a new and useful method for rapid relief of small intestinal obstruction. However, no study reported the impacts of the transnasal ileus tube for Crohn’s disease combined with intestinal obstruction. We aimed to describe the strategy to the small intestine obstruction caused by Crohn’s disease on the basis of transnasal ileus tube insertion.MethodsFrom November 2019 to November 2021, the data of 6 hospitalized patients with CD, diagnosed and conservatively treated in The Second Hospital of Nanjing, were not relived and retrospectively collected. After the insertion of transnasal ileus tube, demographic information, clinical features and treatment data were extracted from medical records.ResultsSix Crohn’s disease patients with intestinal obstruction were included. Half of them were male. The patients aged from 29 to 70 years. Five patients had chronic intestinal obstruction more than one year. Three patients had intestinal surgery history. One patient had colonic abdominal fistula and anastomotic fistula, when she took intermittent usage of sulfsalazine and steroid. On admission, all the patients had abdominal pain, distention and mass. Five patients had anemia, low albumin and cholinesterase. All CDAI scores were more than 400. Compared to 19 patients with incomplete intestinal obstruction improved by nasogastric decompression tube, 6 patients with intestinal obstruction catheter had significant difference in time for relieving abdominal pain and distension (p = 0.003), time for alleviating abnormal mass (p ≤ 0.01), drainage volume (p = 0.004), and preoperative CDAI score (p = 0.001). Compared with X-ray image before insertion, complete remission of obstruction of 5 patients were observed in intestinal cavity after insertion. After 1–2 months nutrition, all the patients had small intestine resection and ileostomy, half of them underwent colectomy and fistula repair, and 4 patients were performed enterolysis at the same time, the residual small intestine length ranging from 250 to 400 cm. 1 patient had permanent ileostomy;1 patient had abdominal infection after operation. The typical manifestations of acute and chronic inflammation, transmural inflammation, pseudopolyps and serous fiber hyperplasia could be seen in pathological findings of patients 1 to 5. All the patients continued enteral nutrition after surgery. Four patients were treated with infliximab or vedolizumab.ConclusionThe current intestinal obstruction catheter which is used to treat patients with Crohn's combined obstruction can afford quick clinical remission, longer nutrition time, and suitable preoperative CDAI score for operation, which is worthy of wildly being used.

The Knowledge of Health Professionals About the Application of Cricoid Pressure in a Low-Income Country: A Single-Center Survey Study.

BackgroundThe application of cricoid pressure requires good knowledge and practice of health professionals who are working in operation theatres to prevent pulmonary aspiration. This study aims to assess the application of cricoid pressure knowledge and practice in health professionals who are working in the operation theatres.MethodsThis survey-based study was conducted in health care professionals who are working in the operation theatre of Debre Tabor Comprehensive Specialized Hospital from November 1 to December 1, 2020. A structured checklist was used to collect data regarding the knowledge and practice of the application of cricoid pressure.ResultsA total of 43 health professionals who are working in the operation theaters were involved in this study with a response rate of 81%. The correct anatomic position of cricoid cartilage was not identified in 67% of nurses. We found that 78% of anesthetists did not use the nasogastric tube for decompression, and 83% of them complain of difficult intubation during the application of cricoid pressure.ConclusionHealth care professionals who are working in operation theatres had poor knowledge and practice in the application of cricoid pressure.

A PROSPECTIVE STUDY ON EARLY ENTERAL NUTRITION FOLLOWING GASTROINTESTINAL SURGERY

Background: The word anastomosis originates from the Greek word meaning communicating opening. Gut anastomosis is one of the frequently performed surgeries. As conventional practice following gut anastomosis, patients are kept “NIL BY MOUTH” till bowel sounds return. During this time period, patient remains with nasogastric tube for decompression of stomach and providing rest to the gut. Aim of the study on early enteral nutrition following gastrointestinal surgery. Methods: A prospective study was carried out over a period of 18 months in dept of General Surgery BMCH Burdwan. The aim of this study was to determine whether early enteral feeding (within 48hrs) after gastrointestinal surgery is tolerable and beneficial to the patient or not. Results: OF 54, 34 were male, 20 were female with a percentage of 63% and 37%. Every patient were given early enteral nutrition and only 6(11.1%) developed paralytic ileus, 16 (29.6%) patients developed gastrointestinal disturbances. Among 29 who underwent anastomosis 3(10.3%) patients had anastomotic leak. Among 54, 9(16.7%) developed SSI (11.1%) developed chest infection. Conclusion: It can be concluded that early enteral feeding induces quicker recovery of postoperative gastrointestinal movements in patients. Early enteral feeding reduces SSI> It is safe and effective I postoperative patients, even if there is apparent ileus. There is no significant correlation between early enteral nutrition and development of complications (ie anastomostic leak, paralytic ileus and postoperative chest infections).

2654 Metastatic Squamous Cell Carcinoma to the Small Bowel Masquerading as Crohn’s Disease: A Diagnostic Dilemma

INTRODUCTION: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common type of cancer in the world. The presence of distant metastasis after the initial treatment of head and neck cancers is associated with a poor prognosis. The most frequent site for distant metastasis of HNSCC is lung, followed by mediastinal lymph nodes, bone and liver. Metastatic squamous cell carcinoma (SCC) to the small bowel is an extremely rare occurrence. We present a unique case of a patient with HNSCC who presented with small bowel obstruction and concern for Crohn’s disease (CD) but was ultimately diagnosed with metastatic SCC. CASE DESCRIPTION/METHODS: A 67 year old Caucasian male with a history of SCC of the left pinna and epiglottis on cisplatin chemotherapy and radiation therapy, presented with 2 weeks of intractable nausea, vomiting, and peri-umbilical abdominal pain. Lab work revealed leukocytosis with WBC 16,000. CT abdomen and pelvis was notable for dilated small bowel loops and a long segment thickening of the distal ileum causing a partial small bowel obstruction (Figure 1). His symptoms persisted despite nasogastric decompressiontube and antibiotics. An abdominal MRI showed similar findings of long discontinuous segments of diffuse distal small bowel thickening, luminal narrowing and mural enhancement with concern for small bowel CD. Given these findings, an empiric course of steroids was initiated. Patient’s symptoms improved and he was discharged from the hospital..To further evaluate the small bowel, he underwent a retrograde balloon enteroscopy, which showed subtle findings of multiple sub-centimeter distal ileal nodules (Figure 2), but no other abnormalities. Biopsies of the nodules returned as metastatic poorly differentiated squamous cell carcinoma (Figure 3). DISCUSSION: Small bowel metastasis represents less than 10% of malignant tumors of the small bowel. Small bowel metastasis from HNSCC is an unusually rare occurrence and to date, there is minimal literature on it’s occurrence. Clinical presentation is variable with acute or sub-acute intestinal obstruction, ileus, gastrointestinal hemorrhage or bowel perforation. Here, we present an unusual case of small bowel metastasis from HNSCC, which is unique given the initial radiologic findings suggestive of CD. Thus, clinicians must be cognizant of the metastatic potential of squamous cell cancer in order to prevent delayed diagnosis and avoid devastating consequences.

Mortality, recurrence, and hospital course of patients with systemic sclerosis-related acute intestinal pseudo-obstruction.

Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of systemic sclerosis (SSc) with few data existing as to its demographics, clinical course, outcomes, and mortality. We undertook a case-control study to describe 64 cases in 37 unique patients, of whom 70% had spontaneous resolution with conservative measures of intravenous hydration and bowel rest, 9% underwent surgical resection, and 25% required prolonged total parenteral nutrition (TPN). Hospital course was for a mean of 12 ± 12.5 days and there was a 16% patient mortality in our population. In a subgroup analysis, patients who had recurrent episodes of pseudo-obstruction were less likely to have esophageal involvement from SSc, and more likely to need prolonged TPN. Mortality tended to be higher in male patients and patients who did not have SSc-related esophageal involvement, and also in patients who had low hemoglobin and serum albumin at presentation. The need for a nasogastric tube for decompression and a surgical intervention correlated with a more prolonged hospital stay. To the best of our knowledge, ours is the largest study looking at this rare manifestation of SSc.

1:54 PM Abstract No. 209 - Interventional treatment of thoracostomach-airway fistula after esophagogastrectomy with covered stents

Purpose To evaluate the clinical value of treating thoracostomach-airway fistula after esophagogastrectomy with covered stents. Materials and Methods Through SCT and digital radiography with water-soluble medium, We diagnosed 22 patients with thoracostomach-airway fistula (6 thoracostomach-tracheal fistulas, 2 thoracostomach-carina fistulas, 13thoracostomach-left principal bronchial fistulas, 1 thoracostomach-right principal bronchial fistula). Covered stents were selected on the base of the site, size and number of thoracostomach-airway fistula.Under the fluoroscopic guidance, 24 stents were implanted in the 22 patients with thoracostomach-airway fistulas. Results Stent placement was technically successful in all patients. The stent completely sealed off the fistula in 18 of 22 patients, choking after drinking and eating vanished as soon as the fistula was closed and a normal diet could be swallowed after the placement of the stents. 4 of 22 patients had persistent aspiration symptoms due to incomplete closure (initial clinical failure). During follow-up, the fistula reopened in 11 of 22 patients with initial clinical success. 8 reopened fistulas were sealed off with stent placement and 3 were inserted a feeding nasoenteric tube and a nasogastric decompression tube. All patients died during follow-up, and mean survival was 14±4.56 weeks (range, 1-42 weeks) after stent placement. Conclusion The airway covered stent placement is an effective and safe treatment for thoracostomach-airway fistula.

Value of nasogastric decompression tube in patients with gastric cancer

To evaluate the effect of nasogastric decompression tube after gastric cancer operation on the postoperative recovery. A total of 174 patients with gastric cancer were prospectively enrolled from December 2009 to March 2011 and randomly divided into non-nasogastric tube control group(n=88) and nasogastric tube group(n=86). Postoperative symptoms, complications, recovery time, and quality of life during hospital stay were compared between the two groups. The incidences of nausea(14.8% vs. 47.7%, P<0.01), sore throat(6.8% vs. 38.4%, P<0.01), bucking and foreign body sensation(3.4% vs. 20.9%, P<0.01), expectoration obstruction(36.4% vs. 55.8%, P<0.05) were significantly lower in nasogastric tube group than those in the control group. The intervals to ambulation and flatus were(1.46±0.58) d and(3.11±0.77) d in the non-nasogastric tube group, significantly shorter those in nasogastric tube group[(1.68±0.61) d and(3.75±1.03) d]. There was no anastomotic leak or bowel obstruction. The difference in bleeding was not statistically significant[3.4%(3/88) vs. 5.8%(5/86), P>0.05] between the two groups. The quality of life differed between the two groups(mean score, 3.36 vs. 2.78, P<0.01). Early removal of nasogastric decompression tube is safe and reasonable and can improve the quality of life during hospital stay.

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

ObjectiveTo retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL).Materials and MethodsFrom January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube.ResultsThe three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months).ConclusionBased on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

Gastric Pneumatosis in a Premature Neonate

Gastric pneumatosis is extremely rare during infancy. It has been reported in association with necrotizing enterocolitis or congenital abnormalities such as pyloric stenosis. Here, we report a case of gastric pneumatosis in a premature neonate on synchronized nasal intermittent positive pressure ventilation. No pneumatosis was noted in the rest of the bowel or esophagus. There could have been mild damage in the gastric mucosa, either related to the placement of the feeding tube or secondary to the use of indomethacin or both. The condition was further aggravated by noninvasive ventilation. An increase in intragastric pressure resulted in the submucosal dissection of air followed by the development of gastric pneumatosis. Conservative management strategies, including the use of a nasogastric tube for decompression and the withholding of feeding, successfully managed the gastric pneumatosis in our patient. An uneventful recovery was made after conservative management. Prompt recognition and evaluation of this condition were essential for making the diagnosis.

Gastrotracheal and Gastrobronchial Fistulas: Management with Covered Expandable Metallic Stents

The present study evaluated the clinical results of covered tracheobronchial metallic stent placement in the management of gastrotracheal fistulas (GTFs) and gastrobronchial fistulas (GBFs). Sixteen patients with GTFs or GBFs after esophagogastrectomy were treated with one of two types of covered tracheobronchial metallic stents: a hinged stent or a straight stent. These included 12 GTFs and four GBFs. Thirteen hinged stents and three straight stents were placed during the initial procedure. Data regarding the technical success of stent placement, initial clinical success and failure, fistula reopening, and complications were obtained. Stent placement was technically successful in all patients. The stent completely sealed off the fistula in 12 of 16 patients (75% initial clinical success rate), whereas the remaining four patients (25%) had persistent aspiration symptoms as a result of incomplete GTF or GBF closure (ie, initial clinical failure). During follow-up, the fistula reopened in three of the 12 patients in whom initial clinical success was achieved (25%). Two reopened fistulas were sealed off with stent placement, and one was treated with a nasoenteric feeding tube and a nasogastric decompression tube. All patients died during the 1-year follow-up period; mean survival time was 17 +/- 3.02 weeks (range, 1-42 weeks) after stent placement. Mean survival in patients in whom initial clinical success was achieved was significantly longer than in patients with initial clinical failure (P = .003; log-rank test). Use of covered metallic stents appears to be a safe and moderately effective procedure to occlude GTFs and GBFs.

Safe Intestinal Decompression in Fresh Postoperative Gastric Bypass

Dilatation of the Roux-limb is sometimes found following Roux-en-Y gastric bypass (RYGBP) procedures. This could be the result of a transient episode due to ileus, or a partial or complete obstruction. The risk of this complication is an increase in intraluminal pressure with the potential for leak. Blind insertion of a nasogastric tube for decompression could be risky due to possible perforation at the stapled or sutured edges. The diagnosis was made with routine extended upper gastrointestinal x-rays 24 hours after surgery. To determine the relationship of the intestinal dilatation, increase in intraluminal pressures and leaks, measurements were taken in porcine models duplicating a RYGBP. Pressures obtained at the anastomoses were higher than pressures in the jejunum between the anastomoses, and related directly to the production of leaks. Elevations of intraluminal intestinal pressures have also been observed in patients who required decompression. The angles of a freshly constructed pouch and the recent stapled or sutured edges may be easily perforated with a nasogastric tube, especially a hard one. We use a soft flexible tube. An angled-end 0.035" wire is introduced into the intestines with fluoroscopic assistance. The tube tip is perforated with a needle, and through this opening, the wire is passed into the tube. The tube is then fed over the wire for safe decompression. Decreasing the intestinal pressure by safe decompression may avoid one of the causes of leaks.

Vacuum assisted closure system in the management of cervical anastomotic leakage after gastric pull-up

We propose the use of the vacuum assisted closure (VAC) system for the management of cervical anastomotic leakage after esophagectomy and reconstruction by gastric pull-up. The VAC system converts the open cervical wound into a controlled closed wound with major advantages: No need of a nasogastric tube for decompression, no need of a nasoenteric tube for feeding because of the possibility to maintain a semisolid oral diet and no need of frequent daily changes of dressings.