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Fri Aug 25 03:29:45 BST 2006

In a message dated 8/24/2006 9:16:21 P.M. Central Standard Time,  
JDuchesne at surgery.umsmed.edu writes:

..........I am stuck with TPN
for now (DISGUSTING IDEA!!).....and my  IR guys doesn't want to attempt
percutaneous small bowel feeding  access..

Maybe I am the only person on this list server that has the courage and  guts 
to suggest this to you.   But I think I would maybe try something  that has 
NEVER been done to my knowledge.   

You say the abdomen is FROZEN, I believe you.   USE the forzen  belly to your 
therapeutic advantage.   

Go to ICU or OR (not IR)
Prep the LUQ
Take a long 22 gauge spinal needle
Aspirate below where the left transverse colon should be
Have a wire ready
When you get BILE push in the wire,
Thread in a tiny catheter and aspirate again.  
IF GOOD Bile is still present push the catheter further
Inject some dye and take an x-ray,   If dye is in colon, pull it  out and do 
it again.,
If in small bowel (ANYWHERE) push it in further and secure it to the  skin
FEED him through the catheter for minimum  of 1 month, while sucking  on NG 
tube
If he tolerates it after the first week.  Put in a new wire
Dilate the channel
Put in a LARGER catheter
Repeat in a week.  

Let me know what you think and what you do.

If anyone on this list has done this BLIND sticking of small bowel in a  
frozen abdomen, take credit for it and write it up tonight.    If  you dont, Im  
going to do it or have one of my faculty or residents write  it up.  

k.

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