Enterostomy Tube Research Articles

Unusual Complication of Gastrostomy

Unusual Complication of Gastrostomy

Tube enterostomy after small bowel resection

Ostomy formation can be technically difficult when mesenteric shortening and thickening are present. In addition, the high output that follows a small bowel ostomy can be debilitating in the elderly patient or the patient with underlying medical illness. We describe a technique to avoid these difficulties.

Enteral Nutrition by Tube

When oral intake is unsatisfactory or contraindicated, maintenance of nutrition by tube feeding is an alternative to the parenteral route. A large volume of research data supports the decision to use the enteral route whenever possible. Entry of food into the alimentary tract is a stimulus to structural and functional maintenance of that tract. Enteral nutrition can be given via indwelling nasoesophageal, pharyngostomy, esophagostomy, percutaneous or surgical gastrostomy, or enterostomy tube. Use of an appropriate catheter, familiarity with the technique used, and careful patient selection and monitoring are important factors in successful tube feeding. Blenderized pet food diets should be fed whenever possible; commercially available liquid diets provide an alternative when tube caliber or patient factors preclude the use of blenderized foods.

Duodenal stump leakage: Causes and prevention

From the aforementioned the corrective measures are for the most part self-evident. First, no effort should be made to tack the proximal loop to the jejunum along the closed-over edge of the stomach so as to protect the corner of the anastomosis. Second, the anastomosis if made posterior should be brought through a rent in the transverse mesocolon which is far enough to the left to allow the stomach remnant to hang freely where it normally belongs. Third, if any difficulty is encountered in the closure of the duodenum or an unsatis-factory closure is obtained, decompressive measures should be instituted either by directing a Levine or Einhorn tube far enough into the proximal loop or by performing a tube enterostomy on this loop. (Fig. 5.) The stomach tube or a large enterostomy tube should be connected to a suction for ninety-six hours as a minimum. This in our experience has on six occasions prevented leakage from duodenal stumps that could only be closed by burying them into the pancreas with one layer of sutures. Fourth, great care should be taken in the dissection of the duodenum when considerable inflammatory reaction exists in the area of the pancreaticoduodenal vessels. It is better to close inadequately this type of duodenum after the method of McNealy 10 in which he enfolds the duodenum on itself than to jeopardize key vessels with resulting avascular necrosis and leakage. Fifth, use only enough saline to replace the actual fluid loss of the patient. Sixth, make an adequate stoma, approximately 6 cm., being sure not to turn in too large a cuff while so doing.