phenylephrine-hydrochloride and Intestinal-Obstruction

The technical difficulties related to the insertion of a long intestinal tube into the jejunum under fluoroscopy present a considerable problem in patients with an intestinal obstruction.. To evaluate the usefulness of endoscopic long intestinal-tube placement with the ultrathin esophagogastroduodenoscope (UT-EGD).. A prospective randomized clinical trial was conducted.. Twenty-eight consecutive patients who presented with an intestinal obstruction were included in the study.. The UT-EGD was inserted nasally into at least the second portion of the duodenum or beyond. After a guidewire was introduced through the working channel, with fluoroscopic guidance, the UT-EGD itself was carefully removed with the guidewire left in place. Next, a hydrophilic intestinal tube was advanced over the guidewire into the jejunum, and then the guidewire was removed.. Primary end points are the total procedure time, the radiation exposure time, and the rate of complications, all compared with the conventional method.. The mean (+/-SD) total procedure time was 18.7 +/- 8.4 minutes for the UT-EGD method and 39.5 +/- 15.0 minutes for the conventional method, with a significant time difference between the 2 methods (P < .0005). The mean (+/-SD) radiation exposure time was also shorter with the UT-EGD method (11.1 +/- 6.0 minutes) than with the conventional method (30.3 +/- 13.7 minutes) (P < .0005). There were no complications, except for mild nasal bleeding with each method.. The UT-EGD method has definite advantages in the placement of a long intestinal tube for patients with an intestinal obstruction in comparison with the conventional method.

Topics: Adult; Aged; Aged, 80 and over; Endoscopes, Gastrointestinal; Endoscopy, Gastrointestinal; Equipment Design; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Male; Middle Aged; Miniaturization; Nose; Prospective Studies

Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.. To determine the appropriate management approach for right-sided malignant colonic obstruction.. Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study. We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents (SEMS). The primary outcome was the overall survival duration (OS) and the secondary endpoints were the disease-free survival (DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.. There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group (5-year OS rate; decompression tube 79.5%, SEMS 32%,. The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.

Topics: Aged; Aged, 80 and over; Anal Canal; Colonic Diseases; Colorectal Neoplasms; Decompression, Surgical; Disease-Free Survival; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Intestinal Obstruction; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Postoperative Complications; Retrospective Studies; Self Expandable Metallic Stents; Survival Rate; Treatment Outcome

This study's aim was to assess the efficacy of intestinal decompression with long tube and selective intestinal radiography in the diagnosis and treatment of small bowel obstruction (SBO) in elderly patients.. Thirty-two elderly patients with SBO received intestinal decompression with a 300-cm long nasointestinal tube inserted into upper jejunum under radiographic control. The long tube was passed into the proximal part of obstruction or the proximal end of ileum driven by intestinal peristalsis. Selective contrast radiography was done using direct injection of double-contrast medium consisting of 20-100 mL of 76% gastrografin and 50-200 mL of air. The dynamic and multi-position radiographic observation was conducted.. Intubation was successful in all 32 patients. SBO resolution was successful in 29/32 (90.6%) patients. The 3 remaining patients proceeded to undergo surgery. Radiographic findings showed no obvious abnormalities in 25/32 (78.1%) patients, adhesive SBO in 6/32 (18.6%), and metastatic intestinal tumor in 1/32 (3.1%) patient.. Decompression using long tube can quickly and effectively relieve obstructive symptoms in elderly patients, and help to avoid emergency surgery and to resolve obstruction. Concurrent contrast radiography is helpful to verify the location and degree of obstruction, and to reveal the cause of the obstruction.

Topics: Aged; Aged, 80 and over; Aging; Catheters; Contrast Media; Decompression, Surgical; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Male; Middle Aged; Nose; Radiography, Abdominal; Retrospective Studies; Risk Factors; Treatment Outcome

The aim of the study is to investigate the efficacy of using targeted enterography during intestinal decompression in the diagnosis of small bowel obstruction (SBO). Thirty-five patients with SBO and who had neither strangulation nor other contradictions received intestinal decompression, under the guidance of X-ray, using a 300-cm-long nasointestinal tube which reached the upper jejunum. Contrast radiography of intestines was performed when the tip of the decompression tube reached the obstruction by administering double-contrast medium, containing 20-100 ml 76 % gastrografin and 50-200 ml air, through the nasointestinal tube. Serial erect and supine plain abdominal radiographs were obtained. Intubation procedure was successful in all 35 patients. SBO was resolved in 20 patients, alleviated in 15 patients and 10 patients received surgery. Selective enterographies showed clear and high quality images. Imaging findings demonstrated no significant abnormality in six patients and adhesive SBO in 15. Furthermore, intestinal tumours were identified in four patients of which three were metastatic tumours and one was an original intestinal cancer; Crohn's disease was confirmed in three patients; radiation enteritis in three (one of them was misdiagnosed and was then confirmed as metastatic tumour during surgery); enteric intussusception was found in two patients; polyps in one patient and carcinoma of the ascending colon in one. Targeted enterography during nasointestinal decompression allows confirmation of pathology of SBO by direct identification of the location, the extent and aetiology of obstruction, thereby providing evidence for the choice of timing and strategy of surgery.

Topics: Adult; Case-Control Studies; Decompression, Surgical; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Jejunum; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Radiography, Abdominal

The aim of this paper was to investigate the effect of non-surgical internal intestinal splinting using an ileus tube under X-ray guidance.. Sixteen patients with recurrent postoperative adhesive small bowel obstruction (SBO) received internal splinting using intubation of a 300 cm long ileus tube. Under X-ray guidance, the tube was advanced through nose, 10 cm beyond the jejunal ligament of Treitz. The tube was advanced towards the end of ileum and propelled by peristalsis using a water-filled anterior balloon of the tube, which directly dilated narrowed intestines. The tube remained in the intestine for further support and splinting.. All 16 patients achieved a resolution of the bowel obstruction without complications. During a follow-up of 8 months to 2 years, 1 patient had a recurrent obstruction 4 months post-procedure. The remaining patients did not experience obstruction recurrence.. Non-surgical, internal intestinal splinting using a nasointestinal ileus tube under X-ray was simple, non-invasive, safe and effective treatment of recurrent adhesive SBO.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Male; Middle Aged; Nose; Radiology, Interventional; Recurrence; Retrospective Studies; Splints; Treatment Outcome

The purpose of this study was to evaluate the safety and efficacy of palliative self-expanding metallic stent (SEMS) placement using a nasal endoscope technique in the context of colorectal malignant obstruction. Eighteen patients with malignant colorectal obstruction who underwent palliative SEMS insertion using a nasal endoscope technique at the Toyonaka Municipal Hospital from August 2005 to August 2011 were enrolled and retrospectively analyzed. In all cases, a guidewire could be inserted on the oral side of the tumor. The placement success rate was 94.4% (17/18), and the complication rate was 23.5% (4 cases). The stent migrated in 3 cases, and perforation occurred in 1 case following bevacizumab chemotherapy. These outcomes indicate that stenting is useful for terminal patients and that nasal endoscopy is useful in cases of difficult guidewire placement.

Topics: Aged; Aged, 80 and over; Colorectal Neoplasms; Endoscopy; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Nose; Palliative Care; Retrospective Studies; Stents; Treatment Outcome

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20-100 ml meglumine diatrizoate 76 % and 50-200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn's disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheters; Decompression, Surgical; Female; Humans; Intestinal Obstruction; Intestines; Intubation; Male; Middle Aged; Nose; Radiography; Young Adult

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant.. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[. the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged.. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d).. The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Topics: Anastomosis, Surgical; Enteral Nutrition; Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Length of Stay; Male; Nose; Postoperative Care; Retrospective Studies; Time Factors; Weight Gain

Topics: Adolescent; Adult; Child; Child, Preschool; Duodenal Obstruction; Duodenum; Humans; Infant; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Intraoperative Care; Intubation, Gastrointestinal; Middle Aged; Nose; Postoperative Complications

A naso-gastric duodenal mercury tip weighted sump tube has been developed that will efficaciously decompress small bowel in cases of paralytic ileus, partial or complete mechanical obstruction, and can easily be introduced into the duodenum by a nurse, house staff or attending physician. The tube also may be used for diagnostic purposes to obtain gastrointestinal, pancreatic or biliary secretions.

Topics: Abdomen; Duodenum; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Mercury; Nose

Topics: Adenocarcinoma; Aged; Cecal Diseases; Colonic Neoplasms; Female; Granuloma; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Mercury; Mercury Poisoning; Mesentery; Nose; Peritonitis; Radiography; Rupture, Spontaneous

Topics: Abdomen; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Nose

Topics: Child; Chloramphenicol; Drug Therapy; Humans; Infant; Intestinal Obstruction; Intubation, Gastrointestinal; New York; Nose; Otitis Media; Penicillin G; Penicillin G Procaine; Procaine; Statistics as Topic