Search

We describe our protocol for performing decompression radiologic gastrostomy and gastrojejunostomy in patients with ascites and small-bowel obstruction. We also assess the technical success rate, the complications, and the morbidity and mortality in 45 patients who underwent radiologic gastrostomy.Forty-five consecutive patients with ascites associated with metastatic ovarian cancer underwent a radiologic gastrostomy or gastrojejunostomy with gastropexy. Six patients underwent gastrostomy, and 39 patients underwent gastrojejunostomy. Locking catheters were placed using the Seldinger technique after gastropexy in all patients. Paracentesis was performed before gastrostomy or gastrojejunostomy. Additional serial paracenteses were performed after the procedure when reaccumulation of ascites close to the site of gastropexy was detected on follow-up sonography.Forty-five procedures were attempted. The technical success rate was 97.8%. The complication rate was 15.6%. Three major complications (6.7%) and four minor complications (8.9%) occurred. One procedure-related death (2.2%) occurred 16 days after gastrojejunostomy.Radiologic gastrostomy and gastrojejunostomy can be performed safely in patients with ascites if the patients undergo paracentesis first and if the reaccumulation of ascites is prevented after tube placement. In patients with ascites, gastropexy plays an important role in preventing pericatheter leakage. Ascites and peritoneal carcinomatosis should not be considered contraindications for radiologic gastrostomy or gastrojejunostomy.

C ase History A 52-year-old woman presented to the emergency department with an acute onset of severe abdominal cramps, feculent vomiting. and a fever of 103#{176}F (39#{176}C). Her medical history was significant: an appendectomy, a cholecystectomy, and an oophorectomy. A clinical diagnosis of small-bowel obstruction was made. A radiograph of the abdomen revealed dilated, fluid-filled smallbowel loops that confirmed the diagnosis. A chest radiograph revealed lung consolidation and a moderate-sized right pleural effusion (Fig. 1A). The emergency department resident performed a diagnostic thoracentesis without image guidance. Cloudy fluid was obtained. Laboratory analysis of the pleural fluid identifled 3500 WBC/pJ with a differential of 73% polymorphonuclear leukocytes. a pH of 7.15, and a glucose level of 31 mg/dl. An immediate Gram’s stain revealed no organisms. The patient was begun on IV antibiotics empirically that included 400 mg of clindamycin every 8 hr, 240 mg of gentamicin every 24 hr. and 1 g of eiythromycin every 6 hr. Subsequent cultures revealed no bacterial growth. A clinical diagnosis of empyema was made. What criteria are used to make this diagnosis, and do these criteria assist in selecting the appropriate treatment? Dr. Mueller. We employ the widely used criteria defined by Light [ I ] in differentiating patients with simple parapneumonic effusions from those with empyemas. The diagnosis of empyema by Light’s criteria requires one of the following features to be present: gross pus. organisms on Gram’s stain, a pH below 7.0, or a glucose level below 40 mg/dl [2]. Light went on to describe three stages in the evolution of empyema. The first is the exudative stage, which occurs when a focus of infection con