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Fri Aug 25 04:53:27 BST 2006

Late breaking news: TPN may not be as disgusting as previously thought.

Gord

Juan Duchesne wrote:

>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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>
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