Leeds Institute of Emergency General Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
BMJ Case Rep. 2022 Feb 28;15(2):e246910. doi: 10.1136/bcr-2021-246910.
Patients with advanced intra-abdominal malignancy frequently experience nausea and vomiting, however these symptoms can be difficult to manage. A woman in her seventies with high grade primary peritoneal adenocarcinoma developed intermittent small bowel obstruction following extensive surgery. Poor relief was provided by pharmacological approaches and nasogastric tube insertion. Further surgical management was deemed unsuitable due to the significant possibility of complications and likely impairment of the patient's quality of life. A conservative approach was used by using a novel therapeutic intervention: an endoscope was used to visualise an enterocutaneous fistula tract proximal to the obstruction and a gastrostomy catheter was fluoroscopically inserted. This maintained fistula tract patency, permitting drainage of bowel contents and therefore resolving the patient's symptoms. We therefore describe a novel therapeutic approach where endoscopic insertion of a gastrostomy catheter maintained patency of an enterocutaneous fistula, enabling lasting relief of bowel obstruction in a manner acceptable to the patient.
患有晚期腹腔内恶性肿瘤的患者常出现恶心和呕吐，但这些症状可能难以控制。一位 70 多岁的女性患有高级别原发性腹膜腺癌，在广泛手术后出现间歇性小肠梗阻。药物治疗和鼻胃管插入对缓解症状效果不佳。由于并发症的可能性很大，并且可能会影响患者的生活质量，因此进一步的手术治疗被认为不合适。通过一种新的治疗干预措施采用了保守方法：使用内窥镜观察梗阻近端的肠皮瘘道，并透视插入胃造口管。这保持了瘘道通畅，允许肠内容物引流，从而解决了患者的症状。因此，我们描述了一种新的治疗方法，其中内窥镜插入胃造口管可保持肠皮瘘道通畅，以患者可接受的方式持久缓解肠梗阻。
