Complications associated with the Baker tube jejunostomy.

1. The jejunostomy route for the intraoperative insertion of a Baker tube carries significant and probably excessive risks. 2. Such risks can be greatly reduced by introducing the Baker tube through a cecostomy or a gastrostomy. When possible, introduction through an ileal stoma or through the rectum when an ileoproctostomy has been performed, is probably even better. 3. For most patients, the cecostomy approach, if performed with great care, will prove to be safe, convenient, and effective.

Rupture of the thoracic esophagus from blunt trauma.

A young man with severe multiple injuries following a motorcycle accident was admitted with head and mandible fractures, coma, fracture dislocation at C5-C6 resulting in total leg paralysis, partial paralysis of the right arm and intercostal muscles, and closed chest injury with possible pulmonary contusion. On the fourth day he developed fulminating mediastinitis and massive empyema, and was found to have a ruptured esophagus. Recovery became possible with surgical drainage of the pleural cavity and mediastinum, proximal and distal decompression of the esophagus, antimicrobial therapy, irrigation of the pleural cavity, complete intravenous hyperalimentation, and infusions of salt-poor albumin. The patient was discharged after 95 days, and 7 months after injury is neurologically intact except for a partial right wrist drop. This rare esophageal rupture should be suspected in any chest injury patients, especially those characterized by extreme cyanosis, dyspnea, shock, and prostration incompatible with thoracic cage injury.