Operative Complications Following Gastrostomy Tube Placement After Cardiac Surgery During Infancy.

INTRODUCTION: Gastrostomy tube (GT) placement is common in infants following repair of congenital heart defects. We aimed to determine rate of operative complications and predictors of short-term GT use to counsel parents regarding the risks and benefits of GT placement. METHODS: We reviewed infants aged <1 y with congenital heart disease who underwent GT placement after cardiac surgery between 2018 and 2021. Demographics and clinical data were collected and analyzed. Comparisons were made between infants who required the GT for more than 1 y and those who required the GT for less than 1 y. RESULTS: One hundred thirty three infants were included; 35 (26%) suffered one or more complication including wound infection (4, 3%), granulation tissue (3, 2%), tube dislodgement (10), leakage from the tube (9), unplanned emergency department visit (15), and unplanned readmission (1). Thirty-four infants used the GT for feeds for 1 y or less (26%) including 17 (13%) who used it for 3 mo or less. Fifty-six infants had their GT removed during the study period (42%), 20 of whom required gastrocutaneous fistula closure (36%). Thirty-three infants had a GT placed on or before day of life 30, 17 (52%) used the GT for less than 1 y, and 10 (31%) used it for 3 mo or less. CONCLUSIONS: GT placement is associated with a relatively high complication and reoperation rate. GT placement in infants aged less than 30 d is associated with shorter duration of use. Risks, benefits, and alternatives such as nasogastric tube feeds should be discussed in the shared decision-making process for selected infants.

Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel syndrome: a case report.

BACKGROUND: Adult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel's syndrome. Literature describing complications related to this pathology remains scarce. CASE PRESENTATION: A 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed. CONCLUSIONS: We present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.

Obstrução gástrica parcial por caroço de cajarana (Spondias cytherea sonn) em filhote de cão - técnicas de imagem para diagnóstico / Partial gastric obstruction caused by cajarana (Spondias cytherea Sonn) in puppies - imaging techniques for diagnosis

Background: Ingestion of foreign bodies is one of the most common cases seen among puppies of dogs in the medical clinics of small animals which may be related to their curious behavior. The diagnosis is based on the patients history, clinical signs, and complementary diagnostic imaging tests. The present case report describes the use of complementary imaging tests, showing a partial gastric obstruction caused by cajarana (Spondias cytherea Sonn) in a puppy.Case: At the Veterinary Hospital of the Federal Rural University of the Semi-Arid Region, a 4-month-old male Yorkshire dog was treated. The guardian reported having witnessed the ingestion of a cajarana stone by the animal. During the physical examination, the animal was active, with good nutritional status, normocorated mucosae, and a moderate degree of dehydration, besides a slight pain on palpation in the epigastric region. Hematological examinations included blood counts, blood urea, creatinine, and alkaline phosphatase. A moderate degree of polycythemia was observed, which may be explained by the dehydration caused by the episodes of vomiting. The patient had frequent episodes of vomiting after the reported event and was then referred to the diagnostic imaging sector. During the sonographic examination, a concave echogenic interface associated with a posterior acoustic shadowing was observed in the region of the stomach. The animal was sent for simple radiographs and positive contrast based on barium sulfate due to the suspicion of the presence of a foreign body. On simple radiography, in the left laterolateral view, a little radiopaque structure of circular format with poor definition was observed in the pyloric region. After the simple radiography, approximately 10 mL of barium sulfate contrast was administered orally followed by a new left lateral radiographic imaging.[...](AU)

Obstrução gástrica parcial por caroço de cajarana (Spondias cytherea sonn) em filhote de cão - técnicas de imagem para diagnóstico / Partial gastric obstruction caused by cajarana (Spondias cytherea Sonn) in puppies - imaging techniques for diagnosis

Background: Ingestion of foreign bodies is one of the most common cases seen among puppies of dogs in the medical clinics of small animals which may be related to their curious behavior. The diagnosis is based on the patient’s history, clinical signs, and complementary diagnostic imaging tests. The present case report describes the use of complementary imaging tests, showing a partial gastric obstruction caused by cajarana (Spondias cytherea Sonn) in a puppy.Case: At the Veterinary Hospital of the Federal Rural University of the Semi-Arid Region, a 4-month-old male Yorkshire dog was treated. The guardian reported having witnessed the ingestion of a cajarana stone by the animal. During the physical examination, the animal was active, with good nutritional status, normocorated mucosae, and a moderate degree of dehydration, besides a slight pain on palpation in the epigastric region. Hematological examinations included blood counts, blood urea, creatinine, and alkaline phosphatase. A moderate degree of polycythemia was observed, which may be explained by the dehydration caused by the episodes of vomiting. The patient had frequent episodes of vomiting after the reported event and was then referred to the diagnostic imaging sector. During the sonographic examination, a concave echogenic interface associated with a posterior acoustic shadowing was observed in the region of the stomach. The animal was sent for simple radiographs and positive contrast based on barium sulfate due to the suspicion of the presence of a foreign body. On simple radiography, in the left laterolateral view, a little radiopaque structure of circular format with poor definition was observed in the pyloric region. After the simple radiography, approximately 10 mL of barium sulfate contrast was administered orally followed by a new left lateral radiographic imaging.[...]

Ingestão de chumbo de pesca em cão - relato de caso / Lead angling sinker intake by a dog - a case report / Ingestión de plomos de pesca en un perro - relato de caso

Corpos estranhos gástricos são encontrados em cães e gatos de todas as raças e idades. Porém, observano tanto a literatura como a rotina nas clínicas e em hospitais, nota-se que animais jovens ingerem corpos estrahos mais comumente que animais adultos. Além do vômito, poderão ocorrer anorexia, depressão e dor abdominal. A radiografia é um método de exame complementar que na maioria das vezes auxilia a diagnosticar a presença desses objetos. Caso não seja possível a remoção do corpo estranho, a gastrotomia deverá ser indicada. O chumbo é um metal tóxico, extremamente danoso quando absorvido pelo organismo. Este trabalho tem por objetivo relatar o caso de uma cadela SRD, com o histórico de ter ingerido grande quantidade de peças de chumbo utilizadas como peso na pesca amadora. A paciente foi submetida a cirurgia para retirada do material estranho, e não chegou a apresentar sintomas de intoxicação pelo metal.

Gastric foreign bodies are found in dogs and cats of all breeds and ages. However, according to the literature and to routine clinics and hospitals, young animals ingest foreign bodies more commonly than adults. In addition to vomiting, anorexia, depression and abdominal pain may also be present. Radiography is a complementary test method that is most often helpful in diagnosing the presence of theses objects. A gastrostomy is indicated when removal of the foreign bodies cannot be achieved. Lead is a toxic metal that is extremely harmful when absorbed by the body. This work reports the case of a mongrel bitch that infested large amounts of lead parts used as weight in angling. The patient underwent surgery for removal of the foreign material, and failed to show symptoms of heavy metal poisoning.

Los cuerpos extraños gástricos pueden ser diagnosticados en perros y gatos de todas las razas y edades. No obstante, tanto en la literatura como en la propia clínica y hospitales se puede observar que los animales jóvenes ingieren los cuerpos extraños con mayor frecuencia que los adultos. Además del vómito, se puede observar cuadros de anorexia, depresión y dolor abdominal. La radiografía es el método complementario que, en la mayor parte de los casos, permite diagnosticar la presencia de esos objetos. Cuando no es posible retirar el cuerpo extraño, se debe indicar una gastrotomía. El plomo es un metal tóxico y extremamente dañino una vez que fue absorbido por el organismo. Este trabajo tienee como objetivo relatar el caso de una perra mestiza, con histórico de haber ingerido una gran cantidade de pedazos de plomo utilizados como peso para pesca. La paciente fue operada para permitir la retirada de cuerpos extraños, y no llegó a presentar síntomas de intoxicación por el metal.

Ingestão de chumbo de pesca em cão - relato de caso / Lead angling sinker intake by a dog - a case report / Ingestión de plomos de pesca en un perro - relato de caso

Corpos estranhos gástricos são encontrados em cães e gatos de todas as raças e idades. Porém, observano tanto a literatura como a rotina nas clínicas e em hospitais, nota-se que animais jovens ingerem corpos estrahos mais comumente que animais adultos. Além do vômito, poderão ocorrer anorexia, depressão e dor abdominal. A radiografia é um método de exame complementar que na maioria das vezes auxilia a diagnosticar a presença desses objetos. Caso não seja possível a remoção do corpo estranho, a gastrotomia deverá ser indicada. O chumbo é um metal tóxico, extremamente danoso quando absorvido pelo organismo. Este trabalho tem por objetivo relatar o caso de uma cadela SRD, com o histórico de ter ingerido grande quantidade de peças de chumbo utilizadas como peso na pesca amadora. A paciente foi submetida a cirurgia para retirada do material estranho, e não chegou a apresentar sintomas de intoxicação pelo metal.(AU)

Gastric foreign bodies are found in dogs and cats of all breeds and ages. However, according to the literature and to routine clinics and hospitals, young animals ingest foreign bodies more commonly than adults. In addition to vomiting, anorexia, depression and abdominal pain may also be present. Radiography is a complementary test method that is most often helpful in diagnosing the presence of theses objects. A gastrostomy is indicated when removal of the foreign bodies cannot be achieved. Lead is a toxic metal that is extremely harmful when absorbed by the body. This work reports the case of a mongrel bitch that infested large amounts of lead parts used as weight in angling. The patient underwent surgery for removal of the foreign material, and failed to show symptoms of heavy metal poisoning.(AU)

Los cuerpos extraños gástricos pueden ser diagnosticados en perros y gatos de todas las razas y edades. No obstante, tanto en la literatura como en la propia clínica y hospitales se puede observar que los animales jóvenes ingieren los cuerpos extraños con mayor frecuencia que los adultos. Además del vómito, se puede observar cuadros de anorexia, depresión y dolor abdominal. La radiografía es el método complementario que, en la mayor parte de los casos, permite diagnosticar la presencia de esos objetos. Cuando no es posible retirar el cuerpo extraño, se debe indicar una gastrotomía. El plomo es un metal tóxico y extremamente dañino una vez que fue absorbido por el organismo. Este trabajo tienee como objetivo relatar el caso de una perra mestiza, con histórico de haber ingerido una gran cantidade de pedazos de plomo utilizados como peso para pesca. La paciente fue operada para permitir la retirada de cuerpos extraños, y no llegó a presentar síntomas de intoxicación por el metal.(AU)

Gastronomia endoscópica percutânea: análise de 35 pacientes / Percutaneous endoscopic gastrostomy: review of 35 patients

Objetivos- avaliar as gastrostomias endoscópicas percutâneas realizadas no serviço de endoscopia do Hospital e Maternidade São Camilo Pompeia/São Paulo, de 01 janeiro de 2008 até 31 junho de 2009, quanto sua indicação, efetividade e índice de complicações. Materiais e métodos- foram realizadas 35 gastrostomias endoscópicas percutâneas pela técnica de tração (pull technique), descrita em 1981 por Ponsky e Gauderer, com o aparelho de endoscopia Olympus Exera CLV 165 e kits de gastrostomia endoscópica percutânea fornecidos pela Wilson Cook e Boston. Todos pacientes receberam antibioticoprofilaxia com cefazolina. Resultados- 13 (37%) pacientes do sexo masculino e 22 (63%) do sexo feminino, com idade variando entre 15 e 95 anos (média de 45 anos). Acidente vascular encefálico foi a principal indicação do método, com 18 (51%) casos. A duração do procedimento variou entre 4 e 14 minutos (média de 7 minutos e 3 segundos). Ocorreu apenas uma complicação imediata. Verificou-se infecção local em 1 (3,5%) paciente, infecção local e em 4 extravasamento do conteúdo gástrico. Conclusões- a gastrostomia endoscópica percutânea é um procedimento de simples e rápida execução, seguro, sem necessitar de laparotomia, anestesia geral ou loco-regional, apresentando baixos índices de morbimortalidade, boa aceitabilidade estética e facilidade de manejo pelos familiares dos pacientes.

Objective- to describe, analyze and evaluate the percutaneous endoscopic gastrostomy at the endoscopic department of the Hospital São Camilo Pompeia / São Paulo from 01 January 2008 to 31 June 2009. Materials and methods- 31 percutaneous endoscopic gastrostomy were performed by pull technique, described in 1981 by Ponsky and Gauderer, using Olympus Evis Exera CLV 165 endoscope and Wilson Cook and Boston Access percutaneous endoscopic gastrostomy kits device. Antibiotic prophylaxis with cefazolina was administered in all patients. Results- 13 (37%) patients were men and 22 (63%) women. Mean age was 45 years old (15 to 95). Stroke was the most commom indication for the procedure, accounting for 18 (51%) patients. Average procedure length was 7 minutes and 3 seconds, ranging from 4 to 14 minutes. Immediate complications occur in 1 patient. Local infection occurred in 1 (3.5%) patient, local infection plus fluids drainage in 4. Conclusions- percutaneous endoscopic gastrostomy is a simple, short and safe procedure, with no need of laparotomy, no general or regional anesthesia, presenting low complications rate, low morbi-mortality, better cosmesis and simple handling for the patients family.