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Nursing Considerations in Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Margaret Birdsong, Michelle Felix
Ostomy: A surgically formed opening from the inside of an organ to the outside. Stoma: The part of the ostomy that is attached to the skin. It is (usually) constructed from the end of the bowel that has been surgically brought up through the skin and attached to the underlying fascia.Ileostomy: A stoma that is created from the small intestine. The output is liquid and may appear to be undigested.Colostomy: Created from the colon and diverted through the abdomen. The output may initially be meconium, becoming yellow and curdy.Jejunostomy: Created from a more proximal section of the small intestine. The output may be quite watery and corrosive to the neighboring skin.Mucous fistula: The other end of the nonfunctioning bowel, which is delivered through the abdomen—the distal bowel end.High-output stoma: Any stoma that produces greater than or equal to 20 mL/kg of effluent. Management of high-output stomas requires careful replacement of gastrointestinal losses and attention to electrolytes in order to prevent complications.
Abdominal trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Steven Stylianos, Mark V. Mazziotti
The authors recommend primary closure of the duodenal perforation whenever possible (Figure 84.10a). Extensive lateral duodenal injury should be treated by primary duodenal repair and pyloric exclusion consisting of temporary closure of the pylorus with an absorbable suture and gastrojejunostomy (Figure 84.10b). Closed suction drainage of the repair is not depicted in this illustration. Feeding jejunostomy is often added to the procedure. When the duodenum is excluded, complete healing of the injury routinely occurs prior to the spontaneous reopening of the pyloric channel and spontaneous closure of the gastrojejunostomy.
Acute Presentation (Boerhaave’s Syndrome)
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Surgery is advocated if the patient has overt signs of sepsis, shock, gross contamination, or has failed non-operative management. The objectives are to restore integrity, clear contamination, and prevent further soiling. Thorough debridement, drainage, lavage, and irrigation are probably more important for survival than the type of repair utilized. A feeding jejunostomy should be fashioned to facilitate enteral feeding and a venting gastrostomy can obviate the need for prolonged nasogastric tube placement.
C-reactive protein and drain amylase: their utility in ruling out anastomotic leakage after minimally invasive Ivor-Lewis esophagectomy
Published in Scandinavian Journal of Gastroenterology, 2023
Sanne K. Stuart, Toon J. L. Kuypers, Ingrid S. Martijnse, Joos Heisterkamp, Robert A. Matthijsen
Combined laparoscopic and thoracoscopic MIE was implemented in our hospital as the standard surgical technique for patients with esophageal cancer in 2015. A nasogastric decompression tube is positioned in the gastric tube proximal to the pylorus during surgery, to prevent stasis and subsequent dilatation of the gastric tube and removed on POD 3, without alarm signs for complications, allowing for an ad libitum intake. Adequate postoperative food intake is guaranteed by a jejunostomy placement. In addition, a Jackson-Pratt (JP) closed suction silicone drain is placed close to the intrathoracic anastomosis in the mediastinum (exteriorized thoracic lateral incision) and removed on POD 5. At the end of the procedure, a chest tube and a redon drain are placed in the right and left hemithorax, respectively. The redon drain can be removed a few hours postoperatively at the postoperative care unit after radiograph showed adequate lung re-expansion and the right chest tube is aimed to be removed on POD 1.
Combined one-stage esophagectomy and duodeno-pancreatectomy for synchronous cancers of the esophagus and pancreatic ampulla in an elderly patient
Published in Acta Chirurgica Belgica, 2021
Matilde de Garcia de la Vega, Bernard Faber, Claude Schalbar, Alain Foxius, Hélène Groot-Koerkamp, Georges Decker
Consequently, 8 weeks after completion of induction chemo-radiotherapy, following a negative laparoscopic exploration, a one-stage radical subtotal esophagectomy was done by laparotomy and right thoracotomy combined with a duodeno-pancreatectomy (Whipple) and their respective lymphadenectomies. Due to planned ligation of the gastro-duodenal artery during the Whipple, a total gastrectomy was required and intestinal reconstruction was done by a long-segment coloplasty with oesophago-colic anastomosis at the level of the aortic arch (Figure 1). For coloplasty, the right colon had to be used due to the patient’s history of sigmoidectomy for diverticulitis. A feeding jejunostomy was also placed. Total operative time was 710 min and total estimated blood loss 700 ml. The post-operative course was complicated by a perforation of the proximal jejunum (erosion by the jejunostomy catheter) requiring relaparotomy for over-sewing at day 10 post-operative (Dindo-Clavien complication grade IIIA). Altogether two units packed red blood cells were transfused during the hospital stay of 35 days and the patient was discharged home without any other subsequent complications.
Nutritional Therapy for Patients with Esophageal Cancer
Published in Nutrition and Cancer, 2018
Taja Jordan, Denis Mlakar Mastnak, Nizra Palamar, Nada Rotovnik Kozjek
Jejunostomy can provide for the patient's nutrition in two different ways. We can administer the nutrients in bolus or continuously by the means of an enteral feeding pump. The dose of the enteral nutrients is adjusted according to the patient's gastrointestinal tolerance. The recommended starting volume of a meal is up to 70 ml (bolus); however, if the patient is experiencing no problems, the dose can be increased. In bolus administration, the size of the bolus and the number of meals is determined on the basis of the patient's nutritional plan. A patient can receive as many as 20 bolus administrations daily. The recommended administration time is 20 min. In continuous administration we act similarly—there are no upper limitations if the patient is not experiencing any problems with the administration of nutrients. Patients who are experiencing a prolonged postsurgical gastrointestinal failure can undergo jejunostomic nutrition at home. Cyclical night feeding with the use of a pump is recommended (34).