SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Percutaneous gastrostomy and gastro-jejunostomy are new techniques which may be used instead of surgical or endoscopic gastrostomy to feed patients with an intact small bowel. We have successfully performed 72 gastrostomies on 67 patients who had had unsuccessful procedures and required surgery. Two patients developed peritonitis when their catheter dislodged into the peritoneal space.
A simplified technique to create the gastro-jejunostomy in an open Roux-en-Y gastric bypass is described. The technique of crossing over circular staple-lines with linear hand-sewn suture-lines instead of the traditional purse-string technique, is depicted. The non purse-string technique has been used in 1,928 cases of mini-open Roux-en-Y gastric bypass with only 2 leaks, an incidence of 0.1%. Weight loss and resolution of co-morbidities have been similar to reports by other investigators.
A 49-year-old female with morbid obesity (BMI 42) underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). 10 months after the operation, she presented to the hospital with intermittent mid-abdominal pain. An internal hernia of the sigmoid colon through a mesenteric defect of the jejuno-jejunostomy was found. Although small bowel internal herniation has been widely documented, the finding of large bowel internal herniation has not been previously reported. Maintaining a high index of suspicion and a low threshold for urgent intervention are required when evaluating patients with vague abdominal complaints after LRYGBP.
A new jejunostomy tube placement technique is described and compared to traditional methods. The interlocking box technique was compared to a simple purse-string with jejunopexy and an inverting serosal tunnel (Witzel technique) with jejunopexy. Procedures performed in fresh canine cadavers were fluid pressure tested following tube removal. Mean+/-standard deviation (SD) intraluminal pressure necessary to induce leakage at the jejunopexy site of the interlocking box group (87.63+/-40.56 cm H2O) was significantly greater (p less than 0.001) than the simple purse-string (43.17+/-31.69 cm H2O) and serosal tunnel (46.33+/-23.60 cm H2O) groups. Significant differences were not identified between the latter groups. The interlocking box technique resisted leakage following acute removal better than conventional techniques and should be tested clinically.
OBJECTIVES: After hepatico-jejunostomy, endoscopic exploration of the biliary tract is not possible, and percutaneous transjejunal catheterization seems to be an attractive option. PATIENTS: This is a 10 year prospective evaluation of 55 percutaneous transjejunal biliary interventions in 53 patients. RESULTS: Thirty nine patients had biliary lithiasis, 10 had suspected recurrent biliary cancer, 5 biliary stenosis, and 1 angiocholitic intrahepatic abscess. Initial success was obtained in all patients and 155 procedures were performed. Interventions included strictures, dilatation, stone extraction, stent insertion and tumor biopsy. The complication rate was 15% (mainly benign biliary sepsis) with no deaths and no surgical reoperations. Thirty two of the 39 patients with biliary lithiasis had successful extraction. Eight of the 10 patients with cancer had an endoscopic biopsy and the 2 others underwent drainage. The 5 patients with benign strictures underwent dilatation and stenting. The intrahepatic abscess was treated completely by drainage. CONCLUSIONS: The feasibility of this technique, the low morbidity and the lack of mortality has been demonstrated. This technique is well accepted by patients and may be an alternative to open surgery which is known to be very difficult and risky in patients who have had one or several prior operations.
The authors report a case of primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophago-jejunostomy in a 76-years-old Caucasian woman. She was affected by esophageal achalasia and in another surgical department underwent gastric resection for adenocarcinoma 6 months before admission. A total gastrectomy performed was due to severity of achalasia symptoms conditioning a high degree of malnutrition. Two years after discharge the patient underwent surgery for total dysphagia, epigastric pain and inexorable weight loss. Histological response was adenocarcinoma of the long arm of Roux-en-y loop. Primary malignancies of the jejunum and ileum are extremely rare and many pathogenetic hypotheses were done but none of them received clinical or experimental demonstration. Symptoms are not specific and diagnosis is difficult and late, x-rays and endoscopy leading to it, US, CT and MNR are useful for differential diagnosis and staging. Prognosis is severe. Surgical therapy is large resection, if possible, but often it is only palliative.
Reestablishment of digestive continuity after radical surgery for severe esophagojejunostomic leakage is a major challenge associated with high morbidity and uncertain feasibility. In this case report we describe a conservative double exclusion technique involving cervical stapling and loop jejunostomy. This technique greatly simplifies subsequent reconstruction and is suitable in most cases.
Insufficiency of anastomosis is one of the main causes of peritonitis. Progressed cachexia due to great losses through intestinal fistulas in combination with peritonitis was the indication to jejunostoma creation. Jejunostomy by Middle in the treatment of postoperative peritonitis due to sutures insufficiency of upper anastomosis of gastrointestinal tract permits to optimize treatment: to realize adequate enteral nutrition, intestinal decompression, to return fistula's losses. Polyorganic insufficiency, number of repeated surgeries and volume of loss through fistulas influence results of the treatment. Respiratory distress-syndrome and errosive bleeding have the most prognostic significance among the syndromes of polyorganic insufficiency.
We compared urinary and fecal excretions of fluid, electrolytes, and nutrients in six patients with a high jejunostomy during three randomized consecutive 3-day periods of total enteral nutrition with three diets differing only by the degree of hydrolysis of the protein moiety: whole proteins, their hydrolysate (63% nitrogen as small peptides with < 1000 M), and the two mixed together. Daily nitrogen absorption was significantly enhanced with the small-peptide and mixed diets (14.3 +/- 3.4 and 13.1 +/- 2 g, respectively) compared with the whole protein diet (10.9 +/- 2.4 g, p = 0.012). Concomitantly, blood urea nitrogen and urinary urea excretion increased with the small-peptide diet. Apparent absorption of fat and calories, fecal weight, and urinary and fecal excretions of sodium, potassium, calcium, and magnesium remained unchanged. We conclude that a small-peptide-based diet may be beneficial in patients with short-bowel syndrome.
The proximal jejunum is the preferred site for long-term enteral access in the patient at risk for aspiration. Herein we describe a laparoscopic technique for the creation of a feeding tube jejunostomy. This minimally invasive approach is an alternative for patients requiring chronic postpyloric enteral feeding.
Laparoscopic surgery of the pancreas, acquisition of the recent years, finds application in the surgical management of pancreatic pseudocysts (PP). Among internal drainage procedures that can be performed through laparoscopic approach, the pseudocysto-jejunostomy technique (PJS) can be performed using only the standard laparoscopic instrument set. We submit the technique we used in performing a PJS on three patients admitted in our clinic. The postoperative outcome was favorable, having obtained identical results to those of the open approach. The mean duration of the interventions was 216.6 minutes. The mean postoperative hospitalization was 7 days. The laparoscopic approach allows internal drainage of PP in the form of PJS to be performed in good circumstances, also bringing about all the specific benefits of this type of surgery.
A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique. The entire procedure is performed under endoscopic visualization. Our experience with more than 100 successful tube placements has made this method common practice at our institute. This technique is ideal for patients with poor gastric emptying of any etiology. We feel that this technique will have an expanding and important role in the future management of this patient population's nutritional problems.
Spontaneous migration of enteral feeding tubes is unusual. We report an 18-year-old man with corrosive stricture of the upper esophagus in whom feeding jejunostomy was performed using an 18F Levine's tube. Thirteen months later, he presented with absence of the tube. The patient was tolerating liquid diet and was managed conservatively. Serial radiographs and colonoscopy showed a steady progress of the tube through the gut. The tube was passed out spontaneously after 20 days.
OBJECTIVE: To investigate the feasibility and safety of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy(PEJ). METHODS: From June 1996 to April 2005, clinical data of 121 patients treated with PEG or PEJ were analyzed retrospectively. RESULTS: A total of 121 patients experienced 134 times of PEG or PEG plus PEJ, including 90 cases (103 times) treated with PEG and 31 patients treated with PEG plus PEJ. Thirteen patients treated with PEG had fistula replacement 6-10 months after PEG. All patients had quick nutrition recovery after fistula tube insert,therefore parenteral nutrition was not required. No severe complications occurred in all patients after 10 months of following-up. Four patients had subcutaneous infection around fistula 4-10 days after PEG. CONCLUSION: PEG and PEJ are safe and new methods for gastrointestinal decompression and enteral nutrition, which can be substitutes for nasogastric tube.
The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.
A 65-year-old female with unresectable advanced gastric cancer accompanied by multiple lung metastases underwent jejunostomy and was treated with TS-1 and CDDP. One course consisted of TS-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14 followed by 14 days rest and CDDP (80 mg/day) was administered by 24-hour continuous intravenous infusion on day 8. After 3 courses, the primary tumor and lymph node metastases decreased in size (PR), and CT scan showed the multiple lung metastases had disappeared. Total gastrectomy (D 2) and splenectomy were performed after chemotherapy. The final diagnosis was Stage IIIA and the pathological response to chemotherapy was Grade 2. The patient has survived for over 14 months after surgery and has presented no signs of recurrence.
Ten patients with obstructive tumors of the upper gastrointestinal tract received a catheter jejunostomy (CJ) for long periods of enteral nutritional support. Seven of those patients received home enteral nutritional support for a period of 2-9 months. Body weight and serum albumin remained constant during the nutritional therapy. Complications (diarrhea, leakage) were rare and could successfully treated without interruption of feeding. In our experience CJ is a safe and effective method for home enteral nutritional support.
Establishment of a percutaneous endoscopic jejunostomy via direct jejunal puncture was accomplished in a 45-year-old woman five years after a partial esophagectomy with cervical esophagogastrostomy for adenocarcinoma of the esophagus. The patient had recurrence of the cancer at the anastomotic site with subsequent inability to eat, necessitating a feeding tube for prolonged enteral nutrition. Although percutaneous puncture of the jejunum has been previously described, it has been limited to patients who had undergone partial or complete gastrectomies with Bilroth II anastomoses. This case report of direct endoscopic jejunal tube placement in a patient after esophagectomy further establishes this procedure as a viable alternative to surgically placed feeding tubes in patients with altered gastric anatomy.