Twelve-year experience with the Thow long intestinal tube: a means of preventing postoperative bowel obstruction.

The purpose of this study was to determine the effectiveness of the Thow long intestinal tube (LIT) for prevention of postoperative adhesive small bowel obstruction (ASBO) and to compare the Thow tube with other LITs. The charts of all patients who had placement of a Thow tube between January 1986 and November 1998 were reviewed. Thirty-four patients ranging in age from 9 to 86 years (mean 57.9) were included in the study. Twenty-five were contacted by phone for long-term follow-up. Twenty-nine patients had undergone previous abdominal surgery, and in 11 of 29 the previous surgery was for ASBO. Indications for surgery and Thow tube placement included: bowel obstruction (25), perforated viscus (five), carcinomatosis (two), colitis (one), and atonic bowel (one). Review of the operative notes revealed no difficulty in advancing the Thow tube in 32 of 34 patients (94%). Thow tube-related complications occurred in nine patients (25%). All complications were associated with the gastrostomy site, and only one patient required surgery for the complication. Two (5.9%) patients developed recurrent obstruction during a mean follow-up of 52 months. In one patient the obstruction was caused by adhesions and in another it was the result of an intra-abdominal abscess. Of 23 patients treated for ASBO at the time of Thow tube placement no patient (0%) developed recurrent ASBO during the follow-up period (total 110.5 patient-years). This study along with a review of the literature suggests that LITs decrease the risk of recurrent ASBO. The Thow tube, however, is easily placed and is associated with fewer and less severe complications than other LITs.

Mucosal enteritis: a complication of the continent ileostomy.

Mucosal enteritis, a nonspecific inflammation of both the mucosa and submucosa, is a complication seen in 13 per cent to 43 per cent of patients with a continent ileostomy. Six cases are presented with emphasis on history, diagnosis, and treatment. Because the inflammation is secondary to an overgrowth of anaerobic bacteria in a functional blind loop, treatment consists of drainage and antibiotics. Metronidazole may be the drug of choice. Refractory cases will benefit only by resection and conversion to a Brooke ileostomy.

Emergency left colon resection with primary anastomosis.

Thirteen cases of emergency left colon resection with primary anastomosis are presented. Production of an empty bowel and use of parenteral hyperalimentation, to delay intake until healing is evidenced by bowel function, are absolutely necessary, The "elective environment," assuring primary healing of the left colon anastomosis, consists of several factors: an empty decompressed bowel with adequate lumen, an antibiotic-depressed colon bacterial flora, assured blood supply, healthy bowel wall, and absence of anastomotic tension. The importance of not extraperitonealizing the anastomosis and the danger of long-term drains are emphasized.

Long-tube gastrostomy with internal intestinal splinting: ten-year experience.

Long-tube bowel splinting at operation, with use of a gastrostomy for introduction of the tube, has many advantages in varying conditions. Results are evaluated in 79 patients undergoing operations, over a 10-year period, for first or recurrent intestinal adhesive obstruction, complicated Crohn's disease, peritonitis, ventral hernia repair, ileostomy, radiation enteritis, etc. Technique and complications are reviewed. Advantages of a recently-developed bi-lumen tube over a single-lumen tube are discussed.

Intraoperative Chaffin sump recto-colonic irrigation.

A simple method for intraoperative rectocolonic irrigation using the time-honored Chaffin sump drain is recommended. It assures an empty particulate matter-free bowel for anastomosis, washes out malignant cells, and provides proof of the integrity of anastomosis and decompression of the proximal bowel when indicated.