Literature DB >> 23225951

Anesthesiologist to surgeons' rescue: An off label use of choledochoscope.

Shiba Aggarwal1, Mritunjay Kumar, Rajeev Uppal, Anirban Hom Choudhuri.   

Abstract

Entities:  

Year:  2012        PMID: 23225951      PMCID: PMC3511968          DOI: 10.4103/0970-9185.101959

Source DB:  PubMed          Journal:  J Anaesthesiol Clin Pharmacol        ISSN: 0970-9185


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Sir, The passage of nasogastric tube (NGT) through an esophageal stricture is a challenge. Strategies suggested to facilitate its passage include generous lubrication; chilling the tube; grasping the thyroid and lifting anteriorly; neck flexion and extension maneuvers; using two fingers in the mouth to facilitate passage of the tube; and direct visualization by laryngoscope, endoscope[1] and glidescope[2]. We used an innovative method of passing the NGT in an urgent situation when all other methods of passing the NGT were unsuccessful. A 30-year-old man with esophageal strictures at C7 and D6- D11 levels following accidental corrosive ingestion was posted for abdominal coloplasty and colonic pull up. After surgical exposure, extensive adhesions of ascending and transverse colon with the stomach were observed. The stomach was extensively scarred and unsuitable for pull up. During mobilization and dissection the vascular integrity of the required colonic segment was compromised despite adequate measures to prevent bowel ischemia by the application of warm towels and delivery of 100 % oxygen. All measures to harvest the required segment of colon for transposition proved unsuccessful. We attempted to pass a 12Fr and 10Fr Ryle's tube (RT) but failed to negotiate it through the stricture. Esophageal intubation with a 5.5 mm ID endotracheal tube was attempted, but it failed. A 5.0 mm ID ETT was successfully passed beyond the upper stricture but a 3.4 mm pediatric fibrescope could not be negotiated through this tube. A 2.5 mm OD choledochoscope (Karl Storz GmbH and Co. KG, Tuttlingen) was passed beyond the stricture. The presence of light channel and maneuverability of its tip facilitated its passage. Gastrostomy was done and 10Fr RT was pulled up retrograde, tied by a thread to the choledochoscope, and brought out through the mouth. A guide wire was inserted through the RT into the esophagus, which was pulled out and serial dilatations done over the guide wire. A 16Fr RT could easily pass antegrade over it. In the end, the gastrostomy was closed, colonic resection and anastomosis was done and patient's trachea extubated.
  2 in total

1.  The GlideScope facilitates nasogastric tube insertion: a randomized clinical trial.

Authors:  Reza Shariat Moharari; Amir Houshang Fallah; Mohammad Reza Khajavi; Patricia Khashayar; Maziar Moradi Lakeh; Atabak Najafi
Journal:  Anesth Analg       Date:  2009-10-27       Impact factor: 5.108

2.  Nasogastric tube insertion in difficult cases with the aid of a flexible nasendoscope.

Authors:  J Der Kureghian; S Kumar; P Jani
Journal:  J Laryngol Otol       Date:  2011-05-31       Impact factor: 1.469

  2 in total

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