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Abstract INTRODUCTION The clinical use of nasal catheter suction-siphonage on over two thousand patients presenting a great variety of pathologic conditions at the University Hospitals during the past four years has amply proved how distention and stasis in the stomach and small intestine may be satisfactorily controlled.1 The technic of its application and the indications and contraindications for its use as well as the results which may be achieved have been reported.2In the following thesis an attempt is made to elucidate some of the mechanicophysiologic principles concerned and the manner in which distention is prevented or preexisting distention is relieved by the use of this method. Historical Background.3 —The use of tubes inserted through the esophagus to relieve gaseous distention probably dates from 1767, when Alexander Monro II, of Edinburgh, employed a flexible tube of coiled wire covered with leather to remove fermenting fluids and gases from References 1. Paine, J. R.; Carlson, H. A., and Wangensteen, O. H.: Post-Operative Control of Distention, Nausea, and Vomiting: Clinical Study with Reference to Employment of Narcotics, Cathartics, and Nasal Catheter Suction-Siphonage , J. A. M. A. 100:1910-1917 ( (June 17) ) 1933.Crossref 2. Wangensteen, O. H., and Paine, J. R.: Nasal Catheter Suction Siphonage: Its Uses and Technic of Its Employment , Minnesota Med. 16:96-100, 1933. 3. Paine, J. R.: History of Invention and Development of Stomach and Duodenal Tubes , Ann. Int. Med. 8:752-763, 1934.Crossref 4. Monro, A.: De dysphagia , Edinburgh, A. Neill & Socii, 1797, p. 83. 5. Kussmaul, A.: Ueber die Behandlung der Magenereweiterung durch eine neue Methode mittelst der Magenpumpe , Deutsches Arch. f. klin. Med. 6:455, 1869. 6. Gross, M.: A Duodenal Tube: Preliminary Communication , New York M. J. 91:77, 1910. 7. Einhorn, M.: A Practical Method of Obtaining the Duodenal Contents in Man , M. Rec. 77:98-101, 1910. 8. Westermann, C. W. J.: Ueber die Anwendung des Dauermagenheber bei der Nachbehandlung schwerer Peritonitisfälle , Zentralbl. f. Chir. 37:356, 1910. 9. Kappis, M.: Einige praktische Winke zur Behandlung des peritonitischen Ileus , München. med. Wchnschr. 58:15-17, 1911. 10. Kanavel, A. B.: Continual Stomach Lavage and Continuous Hypodermoclysis in Peritonitis, Persistent Vomiting with Dehydration, and Dilated Stomach, with a Description of a Modified Stomach Tube , Surg., Gynec. & Obst. 33:483-485, 1916. 11. Matas, R.: The Continued Intravenous "Drip," Ann. Surg. 96:643, 1924. 12. Ward, R.: Apparatus for Continuous Gastric or Duodenal Lavage , J. A. M. A. 84:1114 ( (April 11) ) 1925. 13. Ward, R.: Acute General Peritonitis , California & West. Med. 31:395-398, 1929 14. Acute Dilatation of Stomach , Am. J. Surg. 8:1194-1195, 1930. 15. Wangensteen, O. H.: The Early Diagnosis of Acute Intestinal Obstruction with Comments on Pathology and Treatment—with a Report of Successful Decompression of Three Cases of Mechanical Bowel Obstruction by Nasal Catheter Suction Siphonage , West. J. Surg. 40:1-17, 1932. 16. Paine, J. R., and Wangensteen, O. H.: Necessity for Constant Suction to Inlying Nasal Tubes for Effectual Decompression or Drainage of Upper Gastro—Intestinal Tract , Surg., Gynec. & Obst. 57:601-611, 1933. 17. The following is the method by which the amounts of gas and fluid aspirated by the apparatus are calculated. Readings of fluid levels by the attached calibrated scales when aspiration is begun: Upper bottle 0 cc. Lower bottle 400 cc. Readings of fluid levels after a given period of aspiration: Upper bottle 1,400 cc. Lower bottle 2,300 cc. Gas aspirated is measured directly by reading the fluid level of the upper bottle, i. e., 1,400 cc. Fluid aspirated is obtained by subtracting 1,400 and 400 cc. from 2,300 cc., i. e., 500 cc. 1,400 cc. 2,300 cc. + 400 cc. − 1,800 cc. 1,800 cc. 500 cc. Wangensteen has found by actual measurement at operation that the pressure of gas in the distended small bowel of patients with intestinal obstruction varies from +8 to +24 cm. of water. Plus 12 cm. is the average pressure found. Slight variations in the intra-intestinal pressure affect the calculated results insignificantly. Formula to calculate corrected volume of aspirated gas: VP = V′P′ T T′ V indicates the volume of gas in cubic centimeters as measured in suction apparatus; P, the pressure of gas in centimeters of water as contained in suction apparatus; T, the temperature of gas in degrees centigrade calculated from absolute zero as contained in suction apparatus; V′, the corrected volume of gas in cubic centimeters; P′, the pressure of gas in centimeters of water as present in patient, and T′, the temperature of gas in degrees centigrade calculated from absolute zero as present in the patient. In the example given above the calculation is as follows: 1,000 × 883.6 = V′ × 1,045.6 294 310 883,600 = 1,045.6 V′ 294 310 3,005.44 = 3,37 V′ V′ = 891.8 18. Wangensteen, O. H.: Therapeutic Considerations in Management of Acute Intestinal Obstruction: Technic of Enterostomy and Further Account of Decompression by Employment of Suction Siphonage by Nasal Catheter , Arch. Surg. 26:933-961 ( (June) ) 1933 19. The Management of Acute Intestinal Obstruction with Special Mention of the Character of the Vomiting and Distention , Journal-Lancet 54:640-645, 1934. 20. Wangensteen, O. H., and Paine, J. R.: Treatment of Acute Intestinal Obstruction by Suction with Duodenal Tube , J. A. M. A. 101:1532-1539 ( (Nov. 11) ) 1933. 21. Hibbard, J. S.: Gaseous Distention Associated with Mechanical Obstruction of the Intestine , Arch. Surg. 33:146-167 ( (July) ) 1936. 22. McIver, M. A.; Benedict, E. B., and Cline, J. W.: Postoperative Gaseous Distention of the Intestine , Arch. Surg. 13:588-604 ) (Oct.) ) 1926. 23. When colostomy has been performed for purposes of decompression in patients with obstruction of the large bowel the colon is often opened just enough to allow a rectal tube to be inserted into the lumen of the bowel. The application of suction to such tubes has seemed to aid decompression of the distended segment and lessened the danger of infection which a more complete immediate opening of the colostomy might produce. The application of suction to enterostomy tubes has been practiced as a routine in cases of obstruction of the small bowel in which duodenal suction has not been entirely successful in decompressing the distended loops. These cases have not been studied critically enough to say whether any advantage accrues from such a procedure, but it has permitted us to measure the amount of gas escaping through the enterostomy tube. 24. Sperling, L.: Rôle of the Ileocecal Sphincter in Cases of Obstruction of the Large Bowel , Arch. Surg. 32:22-49 ( (Jan.) ) 1936.Crossref 25. Pratt, G. H.: Intestinal Evacuation by Hydraulic Suction: Further Uses of Suction-Siphonage , Am. J. Surg. 23:148-156. 1933.Crossref
Archives of Surgery – American Medical Association
Published: Dec 1, 1936
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