A case of gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy

A rare complication of percutaneous endoscopic gastrostomy (PEG) is gastrocolocutaneous fistula which usually occurs after replacement of the PEG tube. As tube feeding is directly delivered to the transverse colon, patients typically present with a sudden onset of transient diarrhea within minutes after PEG tube feeding. A radiographic study using water-soluble contrast material via the PEG tube shows the tip of the tube in the transverse colon. We present here a patient who had this complication after PEG insertion. A PEG tube for enteral feeding was placed in a 27-year-old man with cerebral plasty and a severe scoliosis. After replacement of the PEG tube, he developed diarrhea after each PEG tube feeding. The diagnosis of gastrocolocutaneous fistula was made after injection of gastrografin from the PEG tube. Another gastrostomy tube was placed surgically and the fistula was then also excised. In conclusion, gastrocolocutaneous fistula must be considered as a complication of PEG tube placement when patients with a PEG tube develop a sudden onset of transient diarrhea immediately after PEG tube feeding.</p

Application of a First Impression Triage in the Japan Railway West Disaster

On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used “First Impression Triage (FIT)”, our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients

Intracorporeal hemi-hand-sewn technique for Billroth-I gastroduodenostomy after laparoscopic distal gastrectomy: comparative analysis with laparoscopy-assisted distal gastrectomy

Aim: The purpose of this study was to evaluate the clinical feasibility and efficacy of the intracorporeal hemi-hand-sewn (IC-HHS) technique for Billroth-I gastroduodenostomy in comparison with extracorporeal total hand-sewn (EC-THS) anastomosis. We also examined the size of resected specimens in each procedure.Methods: The number of enrolled cases of EC-THS and IC-HHS anastomosis groups were 85 and 110 cases, respectively. Perioperative data and the measured sizes of resected specimens were analyzed.Results: Operation time in the IC-HHS group was significantly longer than the EC-THS group (234.8 min vs. 275.0 min, P &lt; 0.01), whereas intraoperative blood loss was less in the IC-HHS group (48.4 mL vs. 25.4 mL, P = 0.03). There were no procedure-related complications in the IC-HHS group. The greater curvature of the EC-THS group was significantly shorter than the IC-HHS group (214.6 mm vs. 228.7 mm, P &lt; 0.01). There was no correlation between body mass index (BMI) and the length of the greater curvature in the IC-HHS group (r = 0.07, P = 0.47), but in the EC-THS group, the length of the greater curvature tends to shorten as BMI increases (r = -0.45, P &lt; 0.01).Conclusion: IC-HHS technique for Billroth-I gastroduodenostomy revealed feasible with acceptable operation time and postoperative outcome. Another advantage of total laparoscopic distal gastrectomy that intracorporeal transection can facilitate is to ensure an adequate proximal margin, especially in obese middle gastric cancer patients