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1.
OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.  相似文献   

2.
In veterinary patients, postgastric feeding is indicated for uncontrollable gastric vomiting, gastroparesis, biliary tract disease, pancreatitis, and for patients at increased risk for aspirating secondary to decreased mentation, prolonged recumbency, or an unprotected airway. Postgastric feeding may be implemented via the placement of a jejunal feeding tube. These tubes can be placed surgically (jejunostomy tubes) or with fluoroscopic or endoscopic guidance. This article will focus on methods of jejunal feeding-tube placement, advantages and disadvantages of the methods described, and complications associated with jejunal feeding.  相似文献   

3.
Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.  相似文献   

4.
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5.
A cat with pancreatitis, diagnosed using abdominal ultrasonography, fine-needle aspirate cytopathology, and increased concentration of serum trypsin-like immunoreactive substance, was treated successfully using jejunal alimentation provided through a percutaneous gastrojejunostomy tube. This method of jejunal feeding is less technically difficult, less stressful for the patient, and has fewer complications than surgically placed jejunostomy tubes. Nutritional support with jejunal feeding is superior to total parenteral nutrition, as it maintains gut integrity, decreases septic complications, and may reduce exogenous insulin requirements. The methods of tube insertion and maintenance, and the physiological advantages over other feeding methods are described.  相似文献   

6.
Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.  相似文献   

7.
OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.  相似文献   

8.
Five male crossbred dogs successfully underwent surgical placement of button enterostomy tubes to evaluate the placement technique, maintenance and complications of these tubes. Surgical placement was quick, technically straightforward and similar to techniques used for other feeding tubes. None of the dogs experienced life-threatening complications during the 10 month follow-up period. One device required replacement as it was removed by the dog before a permanent fistula had formed. Open tubes due to loose safety plugs and focal cellulitis surrounding the exit sites of these tubes were noted in all dogs. The button tube may be a feasible option for long-term nutritional support in patients with pancreatic, hepatobiliary or gastrointestinal conditions.  相似文献   

9.
The objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31-month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1-61 days). Seventy-one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non-ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.  相似文献   

10.
Objective – To evaluate a method for endoscopically guided nasojejunal tube placement allowing short‐term postduodenal feeding and chyme withdrawal in dogs. Design – Pilot study. Setting – University teaching hospital. Animals – Three healthy Beagle dogs with jejunal nipple valve fistulas. Interventions – After the dogs were anesthetized, an 8 Fr, 250‐cm polyvinyl chloride catheter was advanced through a gastroscope into the jejunum. Correct jejunal placement was established using endoscopic visualization and confirmed by fluoroscopy and radiography. The proximal end of the tube was pulled out through 1 nostril and sutured to the skin of the forehead. Thereafter, jejunal feeding was administered for 4 days. Follow‐up examinations included daily confirmation of the tube's position using radiography, physical examination, and blood analyses. Withdrawal of jejunal chyme was performed after jejunal and oral feeding. Measurements and Main Results – Fluoroscopic examination confirmed that endoscopic visualization alone allowed correct jejunal placement. During a 4‐day postduodenal feeding period, repeated radiographic examination revealed stable positioning of the tubes within the jejunum with minor cranial displacement. The tubes were functional throughout the study without causing identifiable problems. Repeated physical examinations and blood analysis showed no abnormalities. We were able to administer the daily caloric requirements as a liquid diet. Jejunal chyme was successfully withdrawn via the tube. Conclusions – Endoscopically guided nasojejunal tube placement was shown to be a minimally invasive, well‐tolerated method for short‐term jejunal feeding in healthy dogs. This technique is a viable option for dogs requiring jejunal feeding but not laparotomy. The feasibility of chyme sampling is another unique application of the procedure.  相似文献   

11.
Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n=13) or an Eld gastrostomy tube applicator (n=28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n=2), peristomal abscess (n=2) and pyloric outflow obstruction by a migrated tube (n=1). Complications associated with the feeding procedure, nausea and vomiting (n=3), led to aspiration pneumonia in one case.  相似文献   

12.
CASE HISTORY A 3-year-old male Labrador retriever was presented with a history of dietary indiscretion followed by vomiting and abdominal pain.

CLINICAL FINDINGS AND TREATMENT: Abdominal ultrasonography revealed the presence of a fluid-filled cystic structure in the region of the pancreas. Flocculent, dark fluid was drained from the cystic structure during exploratory celiotomy prior to resection of the lateral cystic wall. Omentum was sutured into the cystic cavity to provide drainage and enhance immune response. A jejunostomy feeding tube was placed. Post-surgical care consisted of antibiotic therapy. The dog was clinically normal at 1 and 7 months post-operatively and the pancreas appeared normal on final ultrasonographic examination.

CLINICAL RELEVANCE: This case describes the use of omentum to provide physiological drainage of a pancreatic pseudocyst. This surgical technique may help clinicians manage patients with this condition in the future.  相似文献   

13.
CASE HISTORY: A 3-year-old male Labrador retriever was presented with a history of dietary indiscretion followed by vomiting and abdominal pain. CLINICAL FINDINGS AND TREATMENT: Abdominal ultrasonography revealed the presence of a fluid-filled cystic structure in the region of the pancreas. Flocculent, dark fluid was drained from the cystic structure during exploratory celiotomy prior to resection of the lateral cystic wall. Omentum was sutured into the cystic cavity to provide drainage and enhance immune response. A jejunostomy feeding tube was placed. Post-surgical care consisted of antibiotic therapy. The dog was clinically normal at 1 and 7 months post-operatively and the pancreas appeared normal on final ultrasonographic examination. CLINICAL RELEVANCE: This case describes the use of omentum to provide physiological drainage of a pancreatic pseudocyst. This surgical technique may help clinicians manage patients with this condition in the future.  相似文献   

14.
A new percutaneous insertion technique for esophageal feeding tubes in cats is presented. The technique has been successfully applied in 12 feline patients. The placement technique is relatively simple, takes approximately five minutes to perform, and requires a scalpel blade, a curved hemostat, and an applicator for the insertion of the feeding tube. In contrast to other esophageal tube placement techniques, the tube is inserted into the definitive aboral position in a one-step procedure. Because of its shoehorn shape, the applicator allows the tube to be inserted into the esophagus safely and precisely. Placement of the tube in the midcervical area does not interfere with the function of the pharynx and avoids having the animal irritated by the presence of the tube. The chosen diameter of the tube is large enough to permit feeding of diluted, blended, commercial canned food. For the patients of this study, feeding was started after recovery from anesthesia, and tubes were removed without complications once the animals had started to eat voluntarily.  相似文献   

15.
Results are presented of consecutive percutaneous endoscopic gastrostomies (PEGs) performed in 32 feline and 22 canine patients over a 30-month period. Indications for PEG placement were hepatic disease (33%), esophageal disease (32%), oronasal abnormalities (22%), and cranial nerve deficits (4%), with miscellaneous conditions accounting for 9%. The median duration that PEG tubes were in place was 18 days (range, 0-320 days). The suitability of this feeding technique for clinical use was assessed by evaluating mortality, procedure-related and delayed complications, and body weight changes by the end of the PEG feeding period. Fifty-two of 54 PEGs were placed and used successfully. One fatality occurred during tube insertion due to splenic laceration, and one dog died of aspiration pneumonia secondary to pharyngoesophageal dysfunction. Other than splenic laceration, procedure-related complications were benign pneumoperitoneum (1/54) and minor gastric hemorrhage resulting in melena (1/54). Delayed complications occurring 24 hours or longer after the procedure included aspiration (4/54), peristomal infection or excessive granulation tissue (3/54), and tube extraction or migration (3/54). Nineteen of 54 animals showed evidence of inadequate gastric emptying or volume intolerance when food was introduced after PEG placement. This effect was minor and easily resolved. Of the 44 animals for which follow-up body weight information was available, 19 gained weight, six remained static, and 19 lost weight during the PEG feeding period. Percutaneous gastrostomy is a relatively safe, effective procedure and should be given early consideration for medium- or long-term enteral nutritional support in appropriate canine and feline patients.  相似文献   

16.
A new enterostomy tube placement technique is described for provision of nutrients into the duodenum. Placement of the duodenostomy tube (d-tube) is performed through a limited right flank approach under sedation and local anesthesia. Seven client-owned animals (three dogs and four cats) requiring enteral nutritional support were selected for d-tube placement. Patients were fed via the d-tube for two to 28 days. Complications included discomfort when manipulating and exteriorizing the duodenum, discomfort with bolus feedings, local cellulitis, and tube site infection. All complications resolved without further incident. This technique should be considered in patients that are not good candidates for prolonged general anesthesia or esophageal or gastric feeding, or patients being mechanically ventilated.  相似文献   

17.
Nonendoscopic tube gastrostomy was performed on 41 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum. J Vet Intern Med 1996;10:15–20. Copyright © 1996 by the American College of Veterinary Internal Medicine .  相似文献   

18.
An indwelling stomach tube was placed through a cervical esophagostomy in 5 clinically normal horses and in 3 horses requiring artificial alimentation. In all but one case, surgery was performed on conscious horses following tranquilization and infiltration of the surgical sites with a local anesthetic. Six horses were fed liquid rations through the indwelling tubes, which were left in place from 3 to 26 days. After the tubes were removed, the stomas healed rapidly and with minimal complications. Cervical esophagostomy proved to be a safe, easy, and effective method for the provision of extraoral feeding of the horse.  相似文献   

19.
The purpose of this study was to evaluate complications and owner impressions of a low profile gastrostomy device (LPGD) for enteral feeding in dogs. Medical records of dogs that had placement of a percutaneous endoscopic gastrostomy tube followed by a LPGD between 1995 and 2003 were reviewed. Fifteen dogs had 29 devices placed for a variety of disease states in which enteral nutritional support was indicated. The individual tubes were placed for a median duration of 212 d. Most complications occurred more than 15 d after placement and were of no health risk to the animals. The most common reason for LPGD replacement was leakage through the 1-way antireflux valve. Fourteen of 15 owners that were contacted were supportive of the device. Based on its durability, ease of placement, minor complications, and positive owner impressions, we conclude that the LPGD is a valuable device for long-term enteral nutritional support of dogs.  相似文献   

20.
Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.  相似文献   

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