within the gastrostomy tube a jejunostomy tube that is directed through the pylorus into the duodenum and the proximal jejunum. A gastrojejunostomy tube can be placed percutaneously (Jergens et al. 2007).
4.5.2 Materials and Equipment
A large diameter (28 Fr) gastrostomy (Kangaroo gastrostomy feeding tube, Medtronics, Minneapolis, MN) and a 9 Fr jejunal feeding tube 89 cm long (Kangaroo jejunostomy feeding Tube, Medtronics, Minneapolis, MN) are used. The jejunostomy tube is weighted.
4.5.3 Technique
The gastrostomy tube is placed first as described above. A flexible tip wire is advanced in the jejunostomy tube. The wire‐jejunostomy tube construct is then advanced in the gastrostomy tube and manually directed through the wall of the stomach in the pylorus and the duodenum. The jejunostomy tube is advanced in the proximal jejunum (Figure 4.11). The wire is removed and the jejunostomy tube is flushed to make sure there is no resistance due to a kink. The jejunostomy tube and the gastrotomy tube connect together with a special adaptor in the hub of the gastrostomy tube.
4.5.4 Tips
To facilitate the placement of the jejunostomy tube it is very helpful to advance the gastrostomy tube first through the pylorus. The gastrostomy tube can be manipulated through the stomach wall to be directed into the pylorus. Then it is easier to feed the jejunostomy tube with its wire in the duodenum. It is also very important not to let the jejunostomy tube make a loop in the stomach. If a loop of the jejunostomy tube is in the stomach, it might kink and occlude the jejunostomy tube. Also, if there is a loop in the stomach the jejunostomy tube might migrate back and coil in the lumen of the stomach.
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5 Drainage Techniques for the Peritoneal Space
Eric Monnet
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
5.1 Indications
Drainage of the peritoneal space has been mostly performed for the treatment of peritonitis (Salisbury and Hosgood 1989; Hosgood 1990; Hosgood et al. 1991; Ludwig et al. 1997; Staatz et al. 2002; Buote and Havig 2012; Adams et al. 2014). Septic peritonitis and chemical peritonitis are the two most common conditions that are treated with some form of drainage. The main goal of the drainage is to decrease the bacterial load and/or to reduce the amount of chemical present in the pleural space.
Drainage is mostly indicated for generalized septic peritonitis. Drainage is also indicated if the cause of the peritonitis could not be totally controlled at the time of surgery (pancreatitis). Drainage is also indicated for a septic peritonitis associated with severe contamination with foreign materials (rupture of colon). The risk versus benefit of drainage has not been evaluated in a prospective
