Prolonged Nasogastric Intubation Research Articles

Effect of Different Methods of Abdominal Decompression on the Dynamics of Intra-Abdominal Pressure in the Early Postoperative Period in Patients with Secondary Diffuse Peritonitis: Observational Study

Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial.Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis.Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups.Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome.Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

Prucalopride for the treatment of delayed gastric emptying after pancreaticoduodenectomy: a pilot study

Introduction: Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD) reported in 19–57% of patients. Prucalopride, a 5-hydroxytryptamine, 5HT-4 receptor agonist has been shown to be an excellent drug to treat post-operative ileus. In this pilot study we wanted to test Prucalopride in the treatment of DEG after PD. Methods: We conducted a monocentric study on a consecutive series of PD performed in patients affected by pancreatic adenocarcinomas from January 2013 to December 2017 at IRCCS-ISMETT-UPMC. Patient's demographics, oncologic staging, operative times, intraoperative vitals, and all early surgey-related complications using Clavien grading system were collected and analyzed. Post-operative DGE was determined by the inability to return to a standard diet by the end of the first post-operative week and includes prolonged nasogastric intubation on the patient. Results: There were 96 consecutive patients who underwent PD in our department between January 2013 and December 2017. Multivariate analyses were performed to investigate the effectiveness of the Prucalopride in the treatment of DGE. The overall incidence of DGE was 26,04 % (patients underwent PD: 96, patient with DGE post PD: 25) Of these, 7 patients (6 F, 1 M) were treated with Prucalopride after the failure of medical therapy with common prokinetic (metoclopramide, domperidone). Each of these had a resolution of the DGE with improvement of the outcome and with early discharge. Conclusion: Prucalopride may serve as a post-operative tool for DGE after PD, further studies are needed to validate this proof of concept.

Diffuse Esophageal Squamous Papillomatosis Covering the Entire Esophagus

A 23-year-old woman presented to the clinic with complaints of heartburn and dysphagia with solid foods. Her family history was remarkable for gastric and lung cancer in first-degree relatives. Her physical examination and routine laboratory study results were normal. An upper endoscopy was performed and showed multiple polypoid lesions ranging in size from 3 to 11 mm, involving the entire esophagus (Figure A; Video). An endoscopic polypectomy of several of the larger polyps was performed. Histopathologic examination showed the lesions were squamous papillomas with areas of hyperkeratinization. No dysplastic cells, no inclusion body, and no cytopathic effects were detected (Figure B). Proton pump inhibitor therapy was initiated. Although the patient was human papillomavirus (HPV) negative, she was given the HPV vaccine at the recommendation of Infectious Disease consultants. At a follow-up visit, the patient’s symptoms were improved. Esophageal squamous papillomas are benign epithelial lesions of the esophagus. Incidence has ranged from 0.01% to 0.45%. They are seen as small, whitish-pink, wart-like, exophytic projections. The etiology includes chronic mucosal irritation caused by acid reflux, prolonged nasogastric intubation, smoking, alcohol, and HPV infection. Most lesions cause no symptoms. Lesions smaller than 1 cm usually can be removed by endoscopy, with larger lesions often requiring endoscopic mucosal resection. The prognosis of esophageal squamous papillomas ranges from spontaneous regression to malignant transformation. Malignant transformation has been associated with esophageal stricture, dysphagia, and virulent HPV strains. Informed consent was obtained from the patient for being included in this case report. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJhOTM5MDZlMTNjNzI4NDQwNzhlOWU1N2Y2YWY1NGQ4ZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3OTIwOTIxfQ.ShMkXA5cnn9twry6blcELzlJlmN9784wyzNJ-9ScuTbCXJKYJnhyCAugAlFFQ55xweFf4fR3nO_6-081CiSDBdhjODD3NnID000tmjVJjK-91U-d0ZDzC7juN8xIhmtq8g4Ppt8-QapgjJfBVMUzndBH6Wc8YbReuOgZnL1NonQjPVhenCZCSZQtwaVivSsKPsrfN8bQPsNdp3LVN0Egdg1a12YEmOmvFIk4YtE4nlSgAtzucgvGYeNe8elajLusOAxAO2NIOjp5Dlc0U7PH50bEutnwTCExs2tTImgjRmKSfH3wa6iJNElKAS4Y73Ig2VuFq2SwhrH3tZqILA6TQA Download .mp4 (2.83 MB) Help with .mp4 files Video

Elective Bowel Surgery with or without Prophylactic Nasogastric Decompression: A Prospective, Randomized Trial.

Introduction:Routinely postoperative nasogastric decompression was done until the nasogastric drainage is minimal, reoccurrence of bowel sounds and passing flatus. But prolonged nasogastric intubation is associated with complications like basal atelectasis due to poor cough reflux, loss of electrolytes and increased patient morbidity.Aims and Objectives:To study the need for routine use of nasogastric tube post operatively in bowel surgeries with reference to (1) Return of bowel movements (2) Compare the incidence of complications (3) Duration of hospital stay.Methodology:100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible bowel sounds on auscultation.Results:Incidence of complications were less in the study group i.e., only three patients had vomiting, and two patients had abdominal distension which lead to postponement of oral feeds. Most of our control group patients complained of discomfort and difficulty in coughing and in bringing out sputum, which was the probable cause for high incidence of pulmonary complications.Conclusion:Routine use of the nasogastric tube adjunct to patient care following bowel surgery may be safely eliminated.

Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning

This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future.

P014: Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult ICU in Saudi Arabia

Staphylococcus aureus including MRSA (15.3%), Klebsiella spp. (6.8%), Haemophilus spp. (6.1%), and Enterobacter spp. (5.0%). Acinetobacterspp. and MRSA were significantly associated with late-onset VAP while Haemophilus spp. and Streptococcus pneumoniae were significantly associated with early-onset VAP. Acinetobacter spp. was the only pathogen associated with recurrent VAP and its incidence showed a significant increasing trend during the study period. Acinetobacter spp. was significantly associated with prolonged ventilation, sedation, and nasogastric intubation.

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Case Reports: Aortoesophageal fistula (AEF) is a rare but fatal complication associated with thoracic aortic aneurysm, foreign body ingestion, esophageal malignancy, chest trauma, prolonged nasogastric intubation, and postsurgical fistula formation. Isolated case studies have reported radiation and chemotherapy as etiologies of AEF. Chiari’s triad is classic of AEF and includes mid-thoracic pain or dysphagia, sentinel arterial hemorrhage, and final exsanguination after a symptom free interval. The prompt identification of massive gastrointesitinal hemorrhage that is bright red and arterial in nature is characteristic of AEF. Most cases are unrecognized or misdiagnosed and identified at autopsy. A systematic search for relevant articles, literature reviews, and case reports was performed using The Cochrane Library, PubMed, CINAHL, SCOPUS, and Ovid. Two patients, a 52 yo Arabic male and a 60 yo Hispanic male, both with metastatic squamous cell carcinoma of the esophagus and post-chemotherapy, presented with similar signs and symptoms of hematemesis and hemodynamic instability. They were admitted to the ICU where they subsequently developed uncontrollable hematemesis, requiring massive blood transfusions. Both patients were emergently taken to interventional radiology where AEF was confirmed. Each underwent successful placement of a stent graft in the thoracic aorta. One patient remained hemodynamically stable, was discharged 8 weeks later. The second patient died 72 hours later due to progressive respiratory failure secondary to ARDS associated with massive blood transfusions. The review of the literature indicates that 17% of AEF cases are associated with esophageal cancer. Until the early 2000s, the preferred treatment was surgical intervention. Most recently, case reports have shown endovascular repair (EVR) offers a safe and effective alternative for patients who are not surgical candidates secondary to their physical condition of the disease. Awareness of AEF is low due to the rarity of this pathology, however, early recognition and prompt endovascular intervention can decrease mortality associated with the exsanguination common in patients with AEF.

Reconstruction of a Full-Thickness Alar Wound Using An Auricular Conchal Composite Graft

Nasogastric intubation has become a frequently used method for alleviating gastrointestinal symptoms. Necrosis from alar pressure during prolonged nasogastric and nasotracheal intubation is common, and can result in considerable deformity if it is unrecognized. The reconstruction of full-thickness alar wounds often requires multiple challenging surgical procedures. Difficult full-thickness alar defects often require nasal mucosal replacement for lining, cartilage batten graft support for the preservation of nasal function, and skin coverage for the restoration of an aesthetically correct appearance. Free composite conchal grafting can offer a single-staged, one-step repair of difficult full-thickness alar wounds that are no larger than 1.5 cm in size. A thorough explanation of the graft design and execution is presented, as well as a case report and literature review. Free composite conchal grafting can produce aesthetic and functional results that rival the most sophisticated flap reconstructions of the lateral ala.

Is Endovascular Stent-Graft Treatment of Primary Aortoesophageal Fistula Worthwhile?

Aortoesophageal fistula (AEF) as a result of prolonged nasogastric intubation is rare and certainly fatal, without prompt surgical intervention. We report the case of a 41-year-old man with morbid obesity who was admitted after suffering 55% of total body surface area burns. After several skin graft operations over the course of 12 weeks, he was rushed into surgery because of the acute onset of severe upper gastrointestinal bleeding. Exploratory laparotomy and esophagogastroduodenoscopy (EGD) suggested an AEF, which was then quickly confirmed by a diagnostic angiogram. An endovascular aortic stent graft repair was performed that successfully stopped the bleeding. We include a review of the literature pertaining to cases of AEF treated by endovascular surgery, which appears to be a promising alternative to open surgery in the unfit patient.

Nasogastric tube syndrome: A case report

Nasogastric tube syndrome (NTS) is an uncommon complication of an indwelling nasogastric tube. Ulceration and infection in the posterior cricoid region causes dysfunction in the abduction of the vocal cords and may seriously compromise patients’ airways. This pathology should be considered in patients with prolonged nasogastric intubation who start with moderate pharyngeal pain.We report a case of a 70 year-old woman, admitted to the Neurology department of our centre due to an ischaemic cerebral accident who presented acute dyspnoea requiring emergency tracheotomy following prolonged nasogastric intubation.

Síndrome de sonda nasogástrica: a propósito de un caso

Nasogastric tube syndrome (NTS) is an uncommon complication of an indwelling nasogastric tube. Ulceration and infection in the posterior cricoid region causes dysfunction in the abduction of the vocal cords and may seriously compromise patients’ airway. This pathology should be considered in patients with prolonged nasogastric intubation who start with moderate pharyngeal pain. We report a case of a 70 year-old woman, admitted to the Neurology department of our centre due to an ischaemic cerebral accident who presented acute dyspnoea requiring emergency tracheotomy following prolonged nasogastric intubation.

Double aortic arch and nasogastric tubes: A fatal combination

Double aortic arch is a common form of complete vascular ring that encircles both the trachea and the esophagus, and presents with various respiratory and esophageal symptoms, usually in the pediatric population. We present a case of double aortic arch in an adult patient that manifested as massive upper gastrointestinal bleeding after prolonged nasogastric intubation.

Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. After a literature review on DGE after pancreatic resection, the International Study Group of Pancreatic Surgery (ISGPS) developed an objective and generally applicable definition with grades of DGE based primarily on severity and clinical impact. DGE represents the inability to return to a standard diet by the end of the first postoperative week and includes prolonged nasogastric intubation of the patient. Three different grades (A, B, and C) were defined based on the impact on the clinical course and on postoperative management. The proposed definition, which includes a clinical grading of DGE, should allow objective and accurate comparison of the results of future clinical trials and will facilitate the objective evaluation of novel interventions and surgical modalities in the field of pancreatic surgery.

Double Aortic Arch and Nasogastric Tubes: A Fatal Combination

Purpose: A 38 year old patient was transferred to our hospital for the management of tricuspid valve endocarditis. She had a history of intravenous drug use and had been treated for 2 weeks with intravenous antibiotics but eventually required valvular replacement. On post operative day 11, she developed a massive upper gastrointestinal bleed. An urgent endoscopy showed a large esophageal ulcer with a probable visible vessel at 22 cm from the gums. Endoscopic therapy with epinephrine injections was performed. Two hours later, she bled again, now more severely with secondary shock. Given the location of the esophageal ulcer and the degree of bleeding, a clinical diagnosis of aortoesophageal fistula was made and the patient was taken to the operating room where an aortic endograft was done with control of the bleeding. On review of her records, it was noted that the patient had a double aortic arch completely encasing her trachea and esophagus on a previous CT of her chest. The patient had an NG tube for more than 5 days post op for feeding and medication administration. Discussion: Double aortic arch is a complete vascular ring that encircles both the trachea and the esophagus. The most common presenting symptoms, usually in the pediatric population, are respiratory and gastrointestinal. The incidence of aortoesophageal fistula development in adult patients with double aortic arch and prolonged NG intubation has been reported in the literature, and the pathogenesis of this life threatening complication is probably related to the continuous and pulsatile pressure between the aorta and the esophagus. In this anomaly, the trachea and the esophagus are tightly constricted within a double aortic arch and any inserted tubes can produce pressure necrosis and a resultant fistula. Aortoesophageal fistula is a life threatening complication and its diagnosis can often be delayed in the adult patient without any history of thoracic aortic aneurysms or esophageal malignancy. All imaging modalities to diagnose this entity can be unsuccessful and the best chance for patient survival is a clinical diagnosis made with confidence. We present this case to alert the clinician to another potential and life threatening complication of prolonged nasogastric intubation in this specific patient population. In conclusion, aortoesophageal fistula is a highly fatal but potentially avoidable complication in patients with vascular rings and the risks of prolonged nasogastric intubation in this patient population definitely outweighs the benefits.

Antegrade and retrograde endoscopic approach in the establishment of a neo-esophagus: a novel technique

Although total obstruction or secondary atresia of the esophagus is extremely rare, high-grade strictures are not uncommon. The retrograde approach was previously described to achieve dilation when the conventional antegrade method fails. Gastroenterology laboratory in a tertiary referral center. A 30-year-old man with congenital T-cell immunodeficiency had complete esophageal obstruction after a severe episode of cryptococcal meningitis that required prolonged nasogastric intubation. For the next 3 years, he had daily episodes of regurgitations and several hospitalizations for aspiration pneumonia. A barium study revealed a dilated megaesophagus, with no contrast reaching to the stomach. Initially, a new track was created by using access from above and below the obstruction. This was followed by placement of a self-expandable silicone stent after allowing sufficient time for the new track to mature. Restoration of esophageal continuity, which allowed resolution of the patient's aspiration pneumonia and resumption of oral feeding. Complete esophageal obstruction after prolonged nasogastric intubation is a rare but serious complication. A novel endoscopic approach can be used to restore esophageal continuity, minimize complications, and avoid major reconstructive surgeries.

Antegrade and Retrograde Endoscopic Approach in the Establishment of a Neo-Esophagus

Background Although total obstruction or secondary atresia of the esophagus is extremely rare, high-grade strictures are not uncommon. The retrograde approach was previously described to achieve dilation when the conventional antegrade method fails. Setting Gastroenterology laboratory in a tertiary referral center. Patient A 30-year-old man with congenital T-cell immunodeficiency had complete esophageal obstruction after a severe episode of cryptococcal meningitis that required prolonged nasogastric intubation. For the next 3 years, he had daily episodes of regurgitations and several hospitalizations for aspiration pneumonia. A barium study revealed a dilated megaesophagus, with no contrast reaching to the stomach. Intervention Initially, a new track was created by using access from above and below the obstruction. This was followed by placement of a self-expandable silicone stent after allowing sufficient time for the new track to mature. Main Outcome Measurements Restoration of esophageal continuity, which allowed resolution of the patient's aspiration pneumonia and resumption of oral feeding. Conclusions Complete esophageal obstruction after prolonged nasogastric intubation is a rare but serious complication. A novel endoscopic approach can be used to restore esophageal continuity, minimize complications, and avoid major reconstructive surgeries.

Aortoesophageal fistula due to double aortic arch and prolonged nasogastric intubation: case report and review of the literature

The authors present a patient and describe other cases from the literature which demonstrate that prolonged use of nasogastric tubes can result in life-threatening aortoesophageal fistula formation in patients with a double aortic arch. Aortoesophageal fistula (AEF) is an abnormal communication between the esophagus and the aorta. It can cause massive gastrointestinal hemorrhage. We present an infant with an operatively corrected double aortic arch, who developed this complication after prolonged nasogastric intubation.

Arterioesophageal Fistula: A Rare Complication of Retroesophageal Subclavian Arteries

Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. The purpose of this report is to describe a case involving successful surgical repair of an arterioesophageal fistula induced by prolonged nasogastric intubation. A preoperative CT scan under emergency conditions allowed tentative diagnosis. Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.

Conservative treatment of benign esophageal strictures using dilation. Analysis of 500 cases

The benign esophageal stenoses (BES) are common complications owing to many etiologies: gastroesophageal reflux, ingestion of corrosive agents, esophageal surgery, radiotherapy, postendoscopic variceal sclerotherapy, drug ingestion, prolonged nasogastric intubation, extrinsic compression and esophageal webs. Esophageal dilatations are worldwide recommended to treat this complication, employing dilators of many types and diameters and facilitating the food ingestion. Evaluation of the results and advantages of the conservative treatment of the BES using esophageal dilatations, in outpatient service of upper digestive endoscopy. During the period from 1981 to 1999, 500 patients with BES were treated and followed up at the Gastrocenter - UNICAMP, in an individually Program of Esophageal Dilatation for each case. The highest number of cases was under ages from 31 to 60 years old (52,8%), and males (59,2%). The most predominant etiologies were: peptic stenosis (30,4%), caustic ingestion (23,6%), anastomosis (23,2%), megaesophagus (8,0%) and prolonged nasogastric ingestion entubation (6,4%), totalizing 91,6% of the BES. Most of patients (94,2%) were submitted to the maximum of 25 dilations. Dilators from 10,5 to 16 mm were employed in 95,6% of the cases. The duration of the treatment was 24 months in 76,2% of the BES. Esophageal perforations occurred in 6 patients (1,2%), without mortality. Were considered excellent, good and bad results, respectively in 76,2%, 18,2% and 5,6% of the cases. On the other hand, excellent results were recorded in 81,0% of the peptic stenosis, 66,1% of the caustic stenosis and 82,7% of the anastomotic stenosis. The conservative treatment failed in 9,3% of the caustic stenosis, 4,3% of the anastomotic stenosis and 3,9% of the peptic stenosis. Thus, the caustic stenosis were unsuccessfull in the highest percentage of unsuccessful. The conservative treatment using guidewire dilators (Savary-Gilliard and Eder-Puestow) is the first choice in the BES, is effective for long time, with short complications and the surgical treatment is indicated only when the dilatations failed.

Endoscopic appearance of esophageal hematomas.

Esophageal hematomas develop from the dissection of the mucosa from the mu scular layers of the esophageal wall and represent an uncommon condition affecting all ages[1-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy-some may be spontaneous, particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9]. In this report, we present four cases of esophageal hematomas diagnosed endoscopically, describe their clinical and endoscopic characteristics and propose a classification. As our cases exemplify, therapy is conservative and a favorable prognosis is the rule. Although the diagnosis has traditionally been made by barium esophagography[1] or CAT scanning[1,10], the increased use of endoscopy will allow increased recognition of esophageal hematomas even at a subclinical (asymptomatic) stage and ultimately lead to a better understanding of their etiopathogenesis and their prevention.