Complication During Pancreas Stimulation Test with a Double-Balloon Tube

Abstract

For the determination of the exocrine pancreas function the common Secretin-Pancreozymin Stimulation test was carried out with a double balloon tube (type Bartelheimer). After test termination the tube could not pulled out neither after application of spasmolytic drugs nor with relaxation or general anaesthesia. The removal of the tube was possible only after transcutaneous transduodenal puncture of the invaginated lower balloon with a fine needle under fluoroscopic control.The direct functional test of the pancreas consists of the measurement of excretory enzyme activity in duodenal secretion after stimulation with secretin and pancreozymin. As a rule, a double-balloon Bartelheimer tube (1) or a double-lumen Lagerlöf tube (3) is employed in this test, which is expensive and requires a well-equipped clinical laboratory.With a little practice and under fluoroscopic controll, the tube can be easily brought into the desired position. About 100/o of the patients experience pain in the upper abdomen after the I. V.-injektion of secretin and/or pancreozymin. We have performed 150 examinations with the double-balloon tube in the past five years, however, and have observed no serious complications (2). In fact, complications with this tube have not been reported at all in the literature. The incident described here appears to be the only one of its kind in connection with the Bartelheimer tube.Endoscopy 6 (1974) 199-201 @ Georg Thieme Verlag, Stuttgart Komplikation bei der Pankreasfunktionspriifung mit der Doppelballonsonde Mit einer Doppelballonsonde (BartelheimerSonde) wurde der gewöhnliche Secretin-Pankreozymin-Stimulations-Test zur Untersuchung der exokrinen Pankreasfunktion durchgefiihrt. Nach Beendigung des Testes konnte die Sonde weder nach Applikation von Spasmolytika noch nach Relaxation oder in Vollnarkose herausgezogen werden. Erst nach transkutaner, transduodenaler Punktion des invaginierten unteren Ballons mit einer Feinnadel war die Entfernung der Sonde möglich. Case ReportA 34-year-old businessman, complaining of steadily increasing postprandial pain in the upper abdomen and frequent diarrhea, was admitted to our clinic for diagnosis and therapy. He had been hospitalized here 18 months earlier with similar symptoms after consuming a large amount of alcohol. According to his own admission, he had recently consumed the equivalent of 100 g of pure alcohol daily for the past two months. Upon admission, the patient appeared wellnourished but in reduced general condition. The skin was cool and moist, blood pressure 90/60 mm Hg. The abdomen was distended and extremely guarded and painfully sensitive to pressure in the entire upper area. Bowel sounds were scarce and high-pitched. Laboratory values were as follows: erythrocytes 518 x 104, hemoglobin 17,3 g°/o, hematocrit 49,60/o, leucocytes 13,300; bleeding and prothrombin times normal; electrolytes, total Downloaded by: National University of Singapore. Copyrighted material.