A method for radiologic-assisted gastrostomy when percutaneous endoscopic gastrostomy is contraindicated.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has been established as a faster and safer procedure than open surgical gastrostomy. It cannot be done, however, for many patients with partially obstructing pharyngeal or esophageal carcinoma, previous gastrectomy, upper abdominal surgery, or bowel distension from distal obstruction. PATIENTS AND METHODS: We attempted percutaneous radiologic-assisted gastrostomy (RAG) in 231 patients referred for gastrostomy, 38 of whom had a relative contraindication for PEG. The procedure involves passing, under radiologic guidance, an orogastric inflation tube that contains a snare. We used a 5-inch long, 18-gauge needle to transabdominally insert a wire into the stomach, avoiding loops of bowel visualized by air contrast. Retrieving the transabdominal wire by snare allowed retrograde passage of the gastrostomy tube as done in standard PEG. RESULTS: The procedure was successful in 230 of 231 cases, including 37 of the 38 patients with contraindications. We could not gain gastric access in 1 patient with a 75% gastrectomy. Overall, 6 patients developed complications and 1 died. There was no procedure-related morbidity or mortality in the patients with contraindications to PEG who underwent successful RAG. Subsequent laparotomy indicated tube passage through the liver in 2 of these cases and small bowel mesentery in 1 case without clinical problems. We performed a percutaneous jejunostomy in the efferent limb of the gastrojejunostomy in 1 patient with a previous gastrectomy. CONCLUSION: The snare technique is simpler and faster than the usual radiologic gastropexy technique, and safer than an endoscopic procedure. It has become our procedure of choice for gaining gastric access.

A closed irrigation and drainage system for use with percutaneous abscess drainage: technical note.

A closed irrigation and drainage system has been used in 50 consecutive patients to assess its effectiveness in maintaining catheter patency and draining fluid collections. It consists of an irrigation fluid source, flushing syringe, drainage bag, and tubing to connect the components, and is assembled when the initial drainage procedure is performed. The system emphasizes the use of the siphon effect to maintain constant suction and a closed irrigation and drainage configuration that prevents spread of infection to others and minimizes contamination of the drained cavity. This method of irrigation and drainage also makes patient care considerably easier, and ensures catheter patency.

Pseudo-ureter: a complication of percutaneous nephrolithotripsy.

In 3 previously healthy patients undergoing percutaneous nephrolithotripsy complicated by perforation of the medial wall of the renal pelvis, a false channel or "pseudo-ureter" formed around the ureteric stent catheter, starting from the renal pelvis and re-entering the upper ureter. Recognition occurred 2 to 3 days after lithotripsy during nephrostography and the complication was treated by re-positioning the stent into the true ureteric lumen. All patients are well 7 to 10 months after lithotripsy and there have been no long-term complications.