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He S, Jiang H, Wang H. Iatrogenic Small Intestinal Obstruction. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:717-718. [PMID: 36263808 DOI: 10.17235/reed.2022.9225/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
An 83-year-old female, suffering from abdominal pain, nausea, and vomiting, was admitted to our hospital. Gas-liquid level and tumor was not seen on the abdominal computed tomography scan. Instead, two high density balloon which were 2.7cm(distal) and 3.3cm(proximal) in diameter separately were shown (Figure A) in small intestine. The balloons proved to be part of ileus tube and iohexol which was incorrectly injected into the balloons caused a blockage in the tube. During colonoscopy, we were surprised to find that the distal balloon had passed through the ileocecal valve and we punctured it easily (Figure B). However, affected by the broken distal balloon, we could not reach another one. Finally, we cut off the connector fixed to the face and instructed the patient to take some oral paraffin oil and exercise appropriately. The next day, the balloons were discharged with the symptoms alleviated. It is rare for iatrogenic foreign body to cause ileal obstruction).
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Affiliation(s)
- Shengduo He
- Gastroenterology, Peking University First Hospital, China
| | - Hong Jiang
- Gastroenterology, Peking University First Hospital, China
| | - Huahong Wang
- Gastroenterology, Peking University First Hospital, China
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Wang H, Chen W, Zhou X, Ye T, Gong L, Cai Y. Application of the intestine diversion tube with a double-balloon without ileostomy in low rectal cancer. J Gastrointest Oncol 2023; 14:213-219. [PMID: 36915440 PMCID: PMC10007924 DOI: 10.21037/jgo-22-1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Background Ileostomy is often used in low rectal cancer to protect the anastomosis and reduce the incidence of anastomotic leakage. However, the closure of the stoma causes physical and psychological damage to patients. An intestine diversion tube with a double-balloon was designed to remove the need for ileostomy and a secondary surgery, and we sought to verify its effectiveness and safety. Methods An intestine diversion tube with a double-balloon was designed, and the experiment was performed in 5 groups of experiment pigs by the same group of physicians. The tube was placed into the ileum through the cecum during surgery. All the animals were anatomized after being anesthetized on the 14th day postoperatively to check the anastomosis and abdominal cavity. The postoperative complications included anastomotic leakage, abdominal or pelvic infection, anastomotic stenosis, postoperative bleeding, intestinal obstruction, reoperation, electrolyte disorder, drainage tube blockage, and drainage tube fall off. Results No serious postoperative complications occurred in the 5 animal groups. The average daily drainage tube volume was 188.6 mL, the average drainage tube removal time was 13.4 days, and the average first defecation time was 2.6 days. Postoperative drainage was smooth, and no anastomotic leakage, other complications, or animal deaths occurred. Conclusions The use of the intestine diversion tube with a double-balloon was feasible in animal experiments and was safe and effective. The procedure is simple, and suitable for popularization and application in the clinic.
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Affiliation(s)
- Huipeng Wang
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wenjie Chen
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xiecheng Zhou
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Tao Ye
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Lifeng Gong
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yuankun Cai
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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Tan Y, Yin F, Lu Z, Huang P, Zhang C, Sun J, Wang S, Dong Z. Short-term outcomes of deeper intubation technique of ileus tube for different types of acute intestinal obstruction patients: A retrospective multicenter study. Front Oncol 2022; 12:1065692. [PMID: 36620562 PMCID: PMC9813778 DOI: 10.3389/fonc.2022.1065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Our previous research reported a novel deeper intubation technique (DIT) of the ileus tube for acute bowel obstruction patients. The present study was designed to evaluate the effect of this novel technique on the clinical outcomes of patients with obstruction using a large cohort. Methods The detailed clinical data were analyzed retrospectively from 496 obstruction patients who underwent intubation technique from 2014 to 2019 in five hospitals. The patients were divided into either the DIT group or the traditional intubation technique (TIT) group. The groups were matched in a 1:1 ratio using propensity scores, and the primary outcome was the short-term clinical outcomes for patients. Results The baseline characteristics were similar between the DIT group and the TIT group after matching. Compared with the TIT group, the DIT group had a significantly deeper intubation depth, with shorter hospital days, shorter time to first flatus and defecation, lower pain score, increased drainage volume, and lower emergency surgery rate. Importantly, the inflammatory factors such as white blood cell, C-reactive protein, and procalcitonin levels were significantly lower in the DIT group. In addition, the DIT treatment was significantly useful for adhesive obstruction patients. Conclusion The DIT procedure led to better short-term clinical outcomes compared with the TIT procedure, indicating that DIT is a safe and feasible technique for the treatment of intestinal obstruction that is worthy of further popularization and clinical application.
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Affiliation(s)
- Yanlu Tan
- Department of Interventional Oncology, Central Hospital of Zibo, Zibo, China
| | - Fangxu Yin
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zhihua Lu
- Department of General Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Peng Huang
- Department of Interventional Oncology, Central Hospital of Zibo, Zibo, China
| | - Chengcai Zhang
- Department of Gastrointestinal Surgery, Central Hospital of Zibo, Zibo, China
| | - Jiuzheng Sun
- Department of Hepatobiliary Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Song Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China,*Correspondence: Song Wang, ; Zhensheng Dong,
| | - Zhensheng Dong
- Department of General Surgery, The Fifth Division Hospital, Xinjiang Production and Construction Corps, Bole, China,*Correspondence: Song Wang, ; Zhensheng Dong,
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Miao X, Tao L, Huang L, Li J, Pan S. Application of Laparoscopy Combined with Enhanced Recovery after Surgery (ERAS) in Acute Intestinal Obstruction and Analysis of Prognostic Factors: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5771526. [PMID: 36105936 PMCID: PMC9467727 DOI: 10.1155/2022/5771526] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 11/17/2022]
Abstract
Objective A retrospective cohort study was carried out to research the effect of stent combined with laparoscopy combined with enhanced recovery after surgery (ERAS) in the operation of acute intestinal obstruction and to explore and analyze the prognostic factors. Methods During February 2019 to April 2021, sixty patients with acute intestinal obstruction cured in our hospital were enrolled. Randomly assigned control group patients (n = 50) were divided into the research group and control group patients. The control group accepted stent combined with laparoscopic therapeutic, and the research group accepted stent combined with laparoscopic therapeutic based on ERAS. The general data, operative index, Short Form 36 (SF-36) score, visual analogue scale (VAS) score, procalcitonin (PCT), CRP, prealbumin (PA) index, curative effect, and incidence of complications were investigated. Results No difference was found in age, gender, or type of disease among the general population (P > 0.05). A lower amount of blood was lost during the operation, less anal exhaustion was experienced by the research group, and a shorter hospital stay and lower hospitalization cost was experienced in the research group compared to the control group (P < 0.05). There exhibited no remarkable difference in SF-36 score and VAS score before operation, but after operation, the VAS score lessened, the SF-36 score augmented, while the VAS score was lower, and the SF-36 score in the research group was higher (P < 0.05). There exited no remarkable difference in the indexes of PCT, CRP, and PA before operation, but after operation, the levels of PCT and CRP lessened as well as the level of PA augmented, and the levels of PCT and CRP were lower, while the level of PA in the research group was higher. In terms of the clinical efficacy, the effective rate of the research group (98.00%) was higher compared to the control (86.00%) (P < 0.05). The main postoperative complications were pulmonary infection and incision infection. One case of incision infection occurred in the research group, and the probability of postoperative complications was 2.00%. In the control group, there were 3 cases of pulmonary infection, 0 cases of perforation, and 4 cases of incision infection, and the probability of postoperative complications was 14.00%. The prevalence in the research group was remarkably lower (P < 0.05). Conclusion Compared with the traditional concept of surgical therapeutic, it can more effectively reduce stress reaction, relieve postoperative pain, promote the recovery of postoperative gastrointestinal function as soon as possible, and reduce postoperative complications, which is worth to explore the application in the therapeutic of acute abdomen.
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Affiliation(s)
- Xianglai Miao
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Wuhan, Hubei 430081, China
| | - Lixuan Tao
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Wuhan, Hubei 430081, China
| | - Linfei Huang
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Wuhan, Hubei 430081, China
| | - Jun Li
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Wuhan, Hubei 430081, China
| | - Sheng Pan
- Department of Gastrointestinal Surgery, Wuhan Puren Hospital, Wuhan, Hubei 430081, China
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Zuo L, Cao L, Ding C, Tu H, Wei C, Yuan L, Wang H, Zhang B. Strategy to small intestine obstruction caused by Crohn's disease on the basis of transnasal ileus tube insertion. BMC Surg 2022; 22:183. [PMID: 35568851 PMCID: PMC9107679 DOI: 10.1186/s12893-022-01632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/05/2022] [Indexed: 08/30/2023] Open
Abstract
Background Previous 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. Methods From 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. Results Six 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. Conclusion The 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.
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Affiliation(s)
- Lingyun Zuo
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chengliang Ding
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Hongfei Tu
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Cheng Wei
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Lili Yuan
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huali Wang
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China
| | - Bin Zhang
- Department of Gastroenterology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1 Zhongfu Road, Nanjing, Jiangsu, China.
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