Pulmonary aspiration complicating intraoperative small-bowel decompression: a case report and literature review

• Published in: Canadian Journal of Surgery Vol. 39; no. 6; pp. 495 - 498
• Main Authors: Phillips, I, Jamieson, C G
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact, Inc 01-12-1996; Canadian Medical Association
• Subjects: Adult; Case Report; Decompression - methods; Humans; Intestinal Obstruction - surgery; Intestine, Small - anatomy & histology; Intestine, Small - surgery; Intraoperative Complications - physiopathology; Intraoperative Complications - therapy; Male; Pneumonia, Aspiration - therapy
• ISSN: 0008-428X; 1488-2310

When conservative management of intestinal obstruction fails, the surgeon has two operative choices for decompression: the open procedure with enterotomies and suction and the closed procedure consisting of retrograde stripping and nasogastric suction. A previously undocumented complication of the latter procedure-pulmonary aspiration-is reported in a 20-year-old man with small-bowel obstruction. Practical modifications to the technique of small-bowel decompression are suggested. They include feeding the nasogastric tube into the distal duodenum, using a wider bore tube, inserting an esophageal balloon before extubation, using a nasogastric tube with suction throughout extubation and, immediately postoperatively, making a more conscious effort to remove all gastric contents before extubation, and milking the contents distally through the ileocecal valve.