Nursing Considerations in Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
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.
Thoracoscopic and laparoscopic esophagectomy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
If the patient is having a three-field resection, the esophagus will have been divided in the neck and a tape will have been attached. The esophagus is pulled into the abdomen with the attached tape. A small epigastric incision is made above the umbilicus (see Figure 35.2—dotted line) and a retraction device is placed to retract and to protect the wound. The stomach and esophagus are delivered to construct the gastric tube. The gastric tube is constructed by dividing the tissue on the lesser curve above the crow’s foot region. The stomach is extended and divided with a linear stapling device, allowing a suitable margin from the tumor if lower esophagus, and a tube 5-6 cm wide is constructed with multiple staple applica- tions. The staple line is inverted with sutures. Bulky omental attachments are reduced, ensuring vascularity to the fundus. The tape from the neck is attached to the apex of the fundus and the gastric tube returned to the abdomen. A feeding jejunostomy can be performed at this stage through the small laparotomy wound. The abdominal wound is closed and the abdomen is inflated once more.
The Abdomen
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Whether nutritional support is required should be considered at the definitive operation. Major injuries that precipitate prolonged gastric ileus and pancreatic complications may preclude gastric feeding. A feeding jejunostomy can be used but can lead to technical complications. Sometimes a long nasojejunal feeding catheter can be negotiated past the duodenojejunal flexure, providing a non-invasive alternative. The creation of a percutaneous feeding jejunostomy via the abdominal wall, with the tip sited 15–30 cm distal to the duodenojejunal flexure, will allow early enteral feeding. We prefer elemental diets that are less stimulating to the pancreas and have no greater fistula output than total parenteral nutrition. Total parenteral nutrition is far more expensive but may be used if enteral access distal to the duodenojejunal flexure is impossible.
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.
Effect of direct oral feeding following minimally invasive esophagectomy on costs and quality of life
Published in Journal of Medical Economics, 2021
Madhuri Pattamatta, Laura F. C. Fransen, Annemarie C. P. Dolmans-Zwartjes, Grard A. P. Nieuwenhuijzen, Silvia M. A. A. Evers, Ewout A. Kouwenhoven, Marc J. van Det, Mickael Hiligsmann, Misha D. P. Luyer
The current standard of care is tube feeding via jejunostomy to ensure sufficient intake after esophagectomy. However, weight loss following esophagectomy occurs once tube feeding is stopped23 regardless of the postoperative feeding regimen (oral vs. enteral)24. Moreover, the need for prolonged routine feeding jejunostomy for enteral nutrition is being questioned25–27 due to the frequent occurrence of jejunostomy-related complications23,27, For example, bowel obstruction which is a severe jejunostomy-related complication has been found to be significantly higher in patients that received enteral feeding via a jejunostomy25,28. Furthermore, a randomized pilot study for 6 weeks home enteral nutrition found no clear cost-effectiveness of prolonged enteral feeding29.
A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment
Published in Journal of Investigative Surgery, 2020
Weihang Wu, Zhicong Cai, Nan Lin, Weijin Yang, Jie Hong, Li Lin, Zhixiong Lin, Junchuan Song, Yongchao Fang, Chen Lin, Hongwen Zhang, Dongsheng Chen, Yu Wang
Hemorrhagic shock was induced by controlled bleeding of the jugular artery, with the mean arterial pressure maintained at 40 mmHg for 20 min [11, 14]. Meanwhile, the abdomen was opened with a midline incision. The small intestine was severed at 50 and 105 cm below the ligament of Treitz. The intestinal ischemia model was established by ligating the mesenteric vessels with a small tertiary mesenteric vessel reserved. The free 55-cm small intestine was divided into 11 segments at 5-cm intervals. Adjacent segments were established into normal blood supply intestinal segments and suspected necrotic intestinal segments model. A total of six normal blood supply segments and five intestinal segments suspicious for necrosis were established. In the IR group, EET was performed by reconnecting the segmented intestines with BST. The intact proximal intestine and distal intestine were connected to the main tube, and the free 55-cm intestinal section was connected to the side tube. The tube was inserted 1–1.5 cm into the edge of resection and was secured with cable ties (Figures 2 and 3). In the IL group, the segmented intestine was ligated with silk threads. A proximal jejunostomy tube (16F) was placed for nutritional support later. Thereafter, the abdominal cavity was temporarily closed with TCC (Figure 4). Fluid resuscitation with Ringer’s solution was initiated 30 min after hemorrhagic shock was induced. During 72 h after the EET, all animals were injected with cephalosporin cefazolin sodium (0.5 g, bid) and piperidine (0.5 mg/kg) injection to minimize the infection and pain.
Related Knowledge Centers
- Bowel Resection
- Endoscopy
- Gastrostomy
- Parenteral Nutrition
- Pulmonary Aspiration
- Short Bowel Syndrome
- Small Intestine
- Jejunum
- Minimally Invasive Procedure
- Feeding Tube