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At least 19 recordsLinked to original sources

[Direct percutaneous radiologic jejunostomy (PR) and duodenostomy: a retrospective analysis].

PURPOSE: To present our experience with direct percutaneous radiologic duodenostomy and jejunostomy (PRJ) for alimentation. MATERIALS AND METHODS: A retrospective study identified 24 patients who had undergone percutaneous jejunostomy or duodenostomy guided by CT and fluoroscopy over a period of 9 years. Whenever possible, the jejunum was inflated with a 5 French diagnostic catheter and jejunopexy was performed using Cope anchors (T-fasteners). A 12 to14 French locking pigtail drain was inserted for alimentation. In 8 patients, percutaneous direct jejunostomy was performed using only fluoroscopy. In 9 patients, both CT and fluoroscopy were used to guide the jejunostomy. In all 7 patients who underwent duodenostomy, a combination of CT and fluoroscopy was used. The reports were reviewed for complications and the technical success rate. The technical success rate was determined. RESULTS: Percutaneous radiologic jejunostomy was attempted in 17 patients and failed in 5 patients. PRJ was successful in all 8 procedures guided by fluoroscopy and in 4 of 9 procedures guided by CT and fluoroscopy. Direct percutaneous duodenostomy guided by CT and fluoroscopy was successful in all 7 cases. There were no procedure-related laparotomies and no mortality related to the jejunostomy. Minor complications were infection of the abdominal wall (n = 1), lingering pain requiring a new jejunostomy (n = 1) and aspiration because of persistent reflux (n = 1). CONCLUSION: PRJ is a safe procedure even in critically ill patients. It is technically difficult and may fail if the jejunum cannot be distended. Percutaneous radiologic duodenostomy and jejunostomy are recommended for prolonged alimentation of malnourished patients following esophageal or gastric surgery.

Critical Illness↗

Percutaneous endoscopic gastro-duodenostomy: modified technique.

OBJECTIVES: Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic deficit to avoid repeated tube feeding-related aspiration. We describe a modified technique of endoscopic gastro-duodenostomy. PATIENTS AND METHODS: This technique was performed in 9 patients with severe neurologic deficit. No fluoroscopy was necessary. The gastrostomy button was pushed across the pylorus into the bulb; a nasogastric tube was then placed in the duodenum under endoscopic control and the button was drawn to the gastric wall. When the gastroduodenal tube migrated or was occluded, the button was placed in the bulb through the pylorus and maintained in this position for alimentation. RESULTS: Placement of the gastro-duodenostomy tube was successful without any complication in 100% of patients. The mean duration of the procedure was 15 min. The tube had to be removed for migration (N = 4) and occlusion (N = 5) after a mean period of 5.8 weeks (range: 2-10). During the follow-up period, no tube feeding-related aspiration was observed. CONCLUSION: This modified low-cost technique of endoscopic gastro-duodenostomy is simple and efficient.

Duodenostomy↗

[Clinical experience of percutaneous endoscopic gastrostomy, jejunostomy, duodenostomy in 120 patients].

OBJECTIVE: To report clinical experience of percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy in 120 patients, focusing on its technique and indications. METHODS: One hundred and twenty patients received percutaneous endoscopic gastrostomy, duodenostomy, jejunostomy from May 2001 to April 2004, including 75 percutaneous endoscopic gastrostomy (PEG), 42 percutaneous endoscopic jejunostomy (PEJ), 2 percutaneous endoscopic duodenostomy (PED), 1 direct percutaneous endoscopic jejunostomy (DPEJ). All tubes established by traditional pull technique. RESULTS: The average duration of PEG was (9 +/- 4) min, PEJ (17 +/- 6) min, DPEJ 20 min, and PED was 10 and 12 min for 2 patients, respectively. Success rate of the technique was 98.4% (120/122). Major complication rate was 0.8% (1/120), and minor complication rate was 7.5% (9/120). Clinical indications: PEG, PED and PEJ were applied for long-term enteral nutritional support in 88 patients, gastrointestinal decompression in 25 patients, and transfusing external drainage bile to gastrointestinal tract in 5 patients. Two radiation enteritis patients used PEG for gastrointestinal decompression preoperatively and long-term enteral nutritional support postoperatively. CONCLUSION: PEG, PED PEJ and DPEJ are easily handled, effective and safe, and may be widely used in clinical practice.

Adult↗

[A new method for pseudocysto-duodenostomy as therapy in pancreatic pseudocyst in chronic pancreatitis].

Reference in the surgical literature to the use of pseudocysto-duodenostomy whether laterolateral by Ombredanne [6] or transduodenal by Kerschner [4], is uncommon. The author with the aid of specially designed three-jaw prong, now, prefer to use pseudocysto-duodenostomy. From 1970, 411 patients underwent surgery for complicated chronic pancreatitis. 67 of the 93 patients requiring an internal cysto-intestinal procedure were treated by pseudocysto-duodenostomy; 11 additional patients were treated by derivation in the first retroperitoneal transposed jejunal loop. Postoperative mortality for the first month was 0%. The actuarial survival rate at 5 years was 86.9%. These satisfactory results have encouraged us to compare this new operative method with cystojejunostomy. It allows pancreatic secretions to drain into their natural anatomical site. Compared with external drainage it avoids the often prolonged and costly complications.

Anastomosis, Surgical↗

Effect of octreotide on gastrostomy, duodenostomy, and cholecystostomy effluents: a physiologic study of fluid and electrolyte balance.

OBJECTIVES: Octreotide, a somatostatin analog, reduces stool and fistula outputs by a mechanism that is not completely understood. Our aim was to study its effect on gastrostomy, duodenostomy, and cholecystostomy effluents in a patient with colorectal cancer. METHODS: Effluents of gastrostomy, duodenostomy, and cholecystostomy were collected in three separate shifts over 24-h periods beginning 3 days before octreotide therapy and continuing for 15 treatment days. Fifty-four samples were tested for volume, pH, acid, and bicarbonate production, and biochemical profiles. RESULTS: A positive fluid balance was achieved immediately with octreotide therapy. Significant decreases in gastrostomy and duodenostomy outputs and in gastric acid production were observed (1433.33 +/- 33.33 ml/24 h to 535.71 +/- 55.31 ml/24 h,p < 0.0001; 2066.67 +/- 66.67 ml/24 h to 247.14 +/- 36.04 ml/24 h, p < 0.0001; and 67.50 +/- 3.20 mEq/h to 13.00 +/- 1.50 mEq/h, p < 0.0001; respectively). Gastrostomy tachyphylaxis was observed after 6 days of treatment. Remarkable dose-dependent increases were found in cholesterol and bilirubin concentrations in the cholecystostomy effluent. CONCLUSIONS: Octreotide's primary effect is a decrease in gastric and pancreatic secretions. The increased concentrations of cholesterol and bilirubin may explain the occurrence of gallstones in patients treated with octreotide.

Adenocarcinoma↗

Case report: duodenal and jejunal strictures treated with balloon dilatation through a duodenostomy.

An 11-year-old girl with duodenal and jejunal strictures considered to be inaccessible for surgery was successfully treated using balloon dilatation under fluoroscopic control via a duodenostomy. This is the first reported paediatric case of small bowel stricture dilatation using a balloon catheter, and it is also the first report of the small bowel being approached for balloon dilatation through a duodenostomy. This case demonstrates another use for balloon dilatation which appears to be a relatively safe and effective form of treatment for short, subacute strictures involving the gastro-intestinal tract.

Catheterization↗

Needle catheter duodenostomy: a technique for duodenal alimentation of birds.

A technique for duodenal alimentation (needle catheter duodenostomy) of birds was developed, using the domestic pigeon (Columba livia) as the experimental model. A needle catheter was inserted into the descending duodenum of 5 pigeons and was secured to the body wall and dorsum of each bird. A liquid diet was administered daily (in equal amounts of 0, 4, 8, 12, and 16 hours) for 14 days without adverse effects. On day 15, the catheters were removed, and the birds immediately resumed normal consumption of a pigeon ration and water diet. Although 4 of the 5 birds had minor weight loss, dietary alterations probably could be used on an individual basis to alleviate this problem. After oral alimentation was resumed, the 5 birds exceeded their initial body weight within 7 days. Four weeks after catheter removal, positive-contrast radiographic evaluations indicated that the duodenum of each pigeon appeared normal. Needle catheter duodenostomy was a viable method of alimentation in the domestic pigeon. This technique should be applicable for other avian species requiring bypass of the upper gastrointestinal tract proximal to the region of catheter insertion in the duodenum.

Animals↗

Catheter duodenostomy for perforated duodenal ulcer.

A new technique of catheter duodenostomy is described as treatment for a large perforated duodenal ulcer in a patient who came to the hospital seven days after the perforation. The problem of gastric stasis due to pyloric obstruction was tackled by gastrostomy. Nutritional needs of the patient were met by feeding through the duodenostomy catheter.

Aged↗

[Is Choledocho-duodenostomy in cholelithiasis still justifiable? (author's transl)].

2225 operations for gallstones were performed, from 1961 to 1972 and ended 397 times with choledocho-duodenostomy, 249 times with T-drainage and 84 times with sphincteroplasty. Only risky patients underwent an anastomosis. The mortality rate in all 3 procedures came up to 2.3 to 2.4%. Choledocho-duodenostomy proved to be a useful method especially in old aged people and patients with a high operative risk.

Cholelithiasis↗

[Decompression duodenostomy in the prevention and treatment of incompetence of duodenal stump sutures].

The use of decompressive duodenostomy for the prevention of the incompetence of the duodenal stump sutures of a poorly sutured duodenal stump in stomach resection in 6 cases gave satisfactory results in all the observations. The author is convinced that the decompression of the duodenum by means of the duodenostomy in the incompetence of the duodenal stump sutures decreases significantly the leakage of the intestinal contents between the sutures, which ensures the involution of peritonitis. The patients get rid of an abundant soaking of the bandage, which is very troublesome for them.

Decompression↗

[Immediate and secondary results of duodeno-duodenostomies with tapering in the treatment of total congenital duodenal obstructions in newborn infants].

For the last 5 years, duodeno-duodenostomy with tapering of the dilated duodenal pouch has been the usual method of surgical treatment of complete neo-natal duodenal occlusions. The results of this technic in 25 operated newborns have been compared with those obtained in a previous group of 24 cases operated by technics preserving the duodenal pouch. By restoring the peristaltic efficiency of the upper part of the duodenum, this technic allows early oral feeding (average delay: 7 days), thus avoiding a classical inconvenience of the usual methods of duodeno-duodenostomy or duodeno-jejunostomy. The aetiology of a non-patent anastomosis after the 10th post-operative day is clarified, a persistent duodenal obstruction indicates an organic complication that must lead to re-operation.

Duodenal Obstruction↗

Percutaneous endoscopic duodenostomy (PED). Case report.

Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.

Aged↗

Biliary appendico-duodenostomy: a nonrefluxing conduit for biliary reconstruction.

Biliary conduits constructed during operations for choledochal cysts or biliary atresia are frequently complicated by reflux of gastrointestinal contents, stasis, and obstruction with resulting cholangitis. We have used the appendix as a biliary conduit for cases of biliary atresia and choledochal cyst, adapting the urologic technique of a tunneled, nonrefluxing anastomosis for reconstruction of the biliary tree--biliary appendico-duodenostomy (BAD). From our preliminary experience with this technique, it appears promising.

Anastomosis, Surgical↗

Controlled duodenostomy for difficult duodenal stump.

Three patients with bleeding duodenal ulcer underwent emergency Pólya's gastrectomy for haemostasis after failed endoscopic treatment. Intra-operatively, it was impossible to close the duodenal stump safely because of surrounding fibrosis and scarring. Controlled lateral wall duodenostomy was performed as an attempt to lower the intraluminal pressure of the afferent loop and good results had been observed in all three patients.

Duodenal Ulcer↗

Delayed closure of complex duodenal injuries by a Foley balloon catheter duodenostomy.

Less than 5% of abdominal injuries comprise the duodenum. Treatment is complex with high mortality and morbidity rates. These injuries are usually treated surgically and complications frequently occur. Three cases are presented in this communication in which the injury of the duodenum could not be repaired tension-free. In these cases a Foley balloon catheter was used to close the rupture. After a few weeks, patients were fed through the Foley catheter duodenostomy until a fistular track was formed. On removal of the catheter the fistular track closed spontaneously including the perforation of the duodenum.

Abdominal Injuries↗

Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma.

Nausea and vomiting in patients with advanced gastric malignancy and mechanical obstruction are distressing and difficult to manage. We describe a patient with linitis plastica and gastric stasis who was treated with a percutaneous endoscopic duodenostomy as the stomach could not be used for percutaneous endoscopic gastrostomy (PEG) formation. A Conflo PEG tube was inserted into the second part of the duodenum using the Ponsky-Gauderer technique without complication. The patient experienced excellent symptomatic relief and tolerated enteral nutrition extremely well, regaining some weight. This manoeuvre can produce effective symptom palliation allowing the patient to be managed at home during the terminal phase of their illness.

Administration, Cutaneous↗

Limited approach to the right flank for placement of a duodenostomy tube.

A new enterostomy tube placement technique is described for provision of nutrients into the duodenum. Placement of the duodenostomy tube (d-tube) is performed through a limited right flank approach under sedation and local anesthesia. Seven client-owned animals (three dogs and four cats) requiring enteral nutritional support were selected for d-tube placement. Patients were fed via the d-tube for two to 28 days. Complications included discomfort when manipulating and exteriorizing the duodenum, discomfort with bolus feedings, local cellulitis, and tube site infection. All complications resolved without further incident. This technique should be considered in patients that are not good candidates for prolonged general anesthesia or esophageal or gastric feeding, or patients being mechanically ventilated.

Animals↗

Percutaneous duodenostomy--alternative route for enteral nutrition.

Percutaneous translumbar duodenostomy for enteral feeding was performed in one patient with nutritional difficulties. No complication was encountered. The procedure can be an alternative to percutaneous gastrostomy and jejunostomy for enteral feeding in special situations.

Aged↗