| Popis: |
By using a single lumen long intestinal decompression tube 12 with a mercury weighted balloon tipped head, (Fig. 15), we have been able to intubate successfully 96 per cent of two hundred cases of intestinal distention. The eight failures we believe to be due to a failure to appreciate certain fundamental principles as noted in this paper. The surgeon alone must be responsible for the passage and progress of any intestinal decompression tube if it is to serve the function adequately for which it was designed. It is just as important to pass the long tube properly and adequately decompress the distended abdomen as it is to open that abdomen. It must be realized that the intestinal decompression tube is merely an instrument and must be used as such by the surgeon and not be relegated to the intern or nurse. Intestinal decompression tubes should be used only as an adjunct to surgery in cases of bowel obstruction and must not replace surgery. We classify our cases of intestinal obstruction into four groups for purposes of intestinal intubation. These groups are: 1. Group 1. All cases of ileus due to atony of the bowel, or adynamic and dynamic. All cases in which the obstruction is not in any way mechanical. In this group we use intubation alone. 2. Group 2. All cases of ileus due to inflammatory lesions. In this group would fall all cases of ileus due to general peritonitis, local peritonitis, plastic exudate, inflammatory masses and any inflammatory process capable of causing ileus. In this group intubation alone may be used until all evidence of acute inflammatory reaction has subsided. Most of these patients do not require surgery, although some will be complicated by adhesive bands and must be operated upon before they are well. 3. Group 3. All cases of ileus due to mechanical lesions. These vary from mesenteric thrombosis to carcinoma of the rectosigmoid. All these must be operated upon. Intubation aids in making the working field much easier by collapsing the small bowel. Intubation also gives the surgeon time to prepare the patient properly for surgery and so improves the risk to the patient. 4. Group 4. Patients subjected to selective operations or who would ordinarily have an enterostomy preparatory to anastomosis of bowel or resection. Intestinal intubation obviates the necessity for enterostomy in this type of case. Intestinal intubation should be intrusted only to one who understands the mechanism involved in the passage of the tube and who is willing to spend the time with the patient to insure proper passag. A long intestinal tube in the hands of the novice is indeed a most dangerous instrument. |
