Pulmonary aspiration complicating intraoperative small-bowel decompression: a case report and literature review |
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Authors: | Ian Phillips Christopher G Jamieson |
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Institution: | From the Department of Surgery, The Wellesley Hospital, University of Toronto, Toronto, Ont. |
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Abstract: | When conservative management of intestinal obstruction fails, the surgeon has two operative choices for decompression: the open procedure with enterotomies and suction and the closed procedure consisting of retrograde stripping and nasogastric suction. A previously undocumented complication of the latter procedure — pulmonary aspiration — is reported in a 20-year-old man with small-bowel obstruction. Practical modifications to the technique of small-bowel decompression are suggested. They include feeding the nasogastric tube into the distal duodenum, using a wider bore tube, inserting an esophageal balloon before extubation, using a nasogastric tube with suction throughout extubation and, immediately postoperatively, making a more conscious effort to remove all gastric contents before extubation, and milking the contents distally through the ileocecal valve. |
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