Unusual complications of ballooned feeding tubes.

Percutaneous Endoscopic Gastrostomy (PEG) and Feeding Jejunostomy (FJ) with a Foley catheter are well-established techniques for providing long-term nutritional support. Mechanical complications of these procedures are well recognised. We report two unusual complications of feeding tubes related to the balloon. Patient 1: A 23 years old female cerebral palsy patient had a PEG tube changed to a ballooned gastrostomy tube. Following this she developed abdominal cramps, vomiting and later on haematemesis. Contrast study showed migration of the balloon causing pyloric obstruction and a small prepyloric ulcer. Partially deflating the balloon and pulling it back to the original position corrected this. Patient 2: A 39 years old male cerebral palsy patient with a Foley catheter feeding jejunostomy developed obstructive symptoms within 48 hours of surgery. The balloon was deflated repeatedly without resolution. The catheter was impossible to withdraw and irrigate. Contrast instilled via the balloon channel demonstrated that the catheter was significantly stretched and the balloon was in terminal ileum. The balloon was fully deflated and easily withdrawn to be replaced with uninflated Foley catheter. Enteral feeding was easily reestablished. If a patient with a ballooned feeding tube develops intestinal symptoms balloon complications should be suspected. Contrast study through the feeding channel or balloon inflation channel is useful in diagnosing tube related complication. The threshold for imaging should be low, particularly in patients who are difficult to assess clinically.

Laparoscopic cholecystectomy: experience in a district general hospital.

In many centres laparoscopic cholecystectomy has become the procedure of choice for symptomatic gallbladder stones. By comparison with conventional cholecystectomy it appears to be associated with minimal morbidity, shorter hospital stay, earlier return to work and a better cosmetic result. The present study reviews the results of the first 50 laparoscopic cholecystectomies performed at Altnagelvin Area Hospital.

The release of vasoactive intestinal peptide during altered mid-gut blood flow.

In a series of 17 dogs of which 6 were controls experiments were undertaken to measure arterial and portal vasoactive intestinal peptide (VIP) levels during reduced cephalic mesenteric artery flow states and following reperfusion of the ischaemic mid gut. The flow states examined were basal flow, 50 per cent of basal flow and 25 per cent of basal flow. Zero flow was examined for 20 min and reperfusion of the ischaemic mid gut for 20 min. Peripheral and portal VIP levels were found to be massively elevated during all the flow states studied but particularly during reperfusion of the ischaemic mid gut.