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Fri Aug 25 03:15:06 BST 2006

K- 
It's being 45 days out......his abdomen has granulation tissue ready for
STSG......I lost the window long, long time ago.......I acknowledge
that.........I have useless functional GUT..........I am stuck with TPN
for now (DISGUSTING IDEA!!).....and my IR guys doesn't want to attempt
percutaneous small bowel feeding access..... Will keep you posted.
PS Good work: Top Knife

Juan C Duchesne, M.D.
University of Mississippi Medical Center
Assistant Professor of Surgery/Trauma and Critical Care
2500 North State Street
Jackson MS 39216
>>> KMATTOX at aol.com 08/24/06 8:13 PM >>>
You have a bad situation and you dont have much time left to get out of 
real 
deep trouble.   Your exclusion is not going to open up as you  want it
to do. 
  You are going to get a quatranary duodenal blowout,  from which you
and the 
patient will not  survive.       If you wait much longer, you will  be
unable 
to do a gastrojejunostomy because of the foreshortening of the 
mesentery.    
 It already may be too late.   

You have to get some hook up between the stomach and the jejunium or you
 are 
going to have a frozen abdomen and be on IV alimentation for a long
time,  
with a good gut there unused.    

I would recommend going in abdomen, assuring that you have a closed
pylorus  
at the pylorus and then do either a Roux en Y or a loop 
gastrojejunostomy.   
BE SURE TO BE ON THE DEPENDENT PROTION OF THE  GREATER CURVE.   

DO NOT DO A VAGOTOMY.   

Drain the RUQ .  Put in TWO tubes into the stomach,   One  for drainage
and 
one threaded through the gastrojejunostomy and far down into  the
jejunium

Buy Top Knife.  

k
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Pyloric exclusion