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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report | Hara et al. Journal of Medical Case Reports 2011 5 55 http www.jmedicalcasereports.eom content 5 1 55 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries a case report Masayasu Hara Satoru Takayama Hiromitsu Takeyama Abstract Introduction The management of intestinal injury can be challenging because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries. Case presentation A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation with signs consistent with systemic inflammatory response syndrome body temperature 38.5 C heart rate 92 beats minute respiratory rate 23 breaths minute white blood cell count 11.7 X 109 L normal range 4-11 X 109 gL . Two further surgical interventions failed to control the leak and our patient s clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention the intestinal leak gradually closed and oral feeding became possible. Conclusion We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage and is less invasive than a nasojejunal tube. Introduction Repeated surgical operations are sometimes the cause of severe intestinal adhesions. Surgery for such .
