Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection

Marvin, Robert G.; McKinley, Bruce A.; McQuiggan, Margaret M.; Cocanour, Christine S.; Moore, Frederick A.

doi:10.1016/s0002-9610(99)00261-5

Cited by 153 publications

(92 citation statements)

References 18 publications

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“…There may be evidence of pneumatosis intestinalis with intramural gas in the intestinal wall, and sometimes in the portal vein and liver. Occasionally mild NOMI can be managed conservatively by addressing the risk factors, but usually, it requires surgery and bowel resection [14]. As surgery is usually within the first week, the abdomen can be lavaged and any early collections drained, but the surgeon should not be tempted to expose, drain or debride the pancreas ('don't poke the skunk').…”

Section: Surgical Treatment Of Non-occlusive Intestinal Ischaemia Andmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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Section: Surgical Treatment Of Non-occlusive Intestinal Ischaemia Andmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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“…6,[8][9][10]12,13 There was no obvious difference in incidence between the unit routinely inserting NCJs and the unit selectively inserting TJs (1.16 versus 1.06%). This finding is in line with other series: the reported incidence after routine insertion of an FJ has ranged from 0% among 262 patients reported by Sica and colleagues It has been suggested that NOSBN is the result of early aggressive enteral feeding.…”

Section: Non-occlusive Small Bowel Necrosis In Association With Feedimentioning

confidence: 88%

“…The type of enteral formula could play ar ole. 12 All our patients received ap olymeric formula. Perhaps am ore refined elemental diet would have been better tolerated, yet it may not avoid NOSBN (Table 3).…”

Section: Non-occlusive Small Bowel Necrosis In Association With Feedimentioning

confidence: 99%

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Non-Occlusive Small Bowel Necrosis in Association with Feeding Jejunostomy After Elective Upper Gastrointestinal Surgery

Spalding

Behranwala

Straker

et al. 2009

annals

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INTRODUCTION Non-occlusive small bowel necrosis (NOSBN) has been associated with early postoperative enteral feeding. The purpose of this study was to determine the incidence of this complication in an elective upper gastrointestinal (GI) surgical patient population and the influence of both patient selection and type of feeding jejunostomy (FJ) inserted, based on the experience of two surgical units in affiliated hospitals.PATIENTS AND METHODS The records were reviewed of 524 consecutive patients who underwent elective upper GI operations with insertion of aF Jf or benign or malignant disease between 1997 and 2006. One unit routinely inserted needle catheter jejunostomies (NCJ), whilst the other selectively inserted tube jejunostomies (TJ).RESULTS Six cases of NOSBN were identified over 120 months in 524 patients (1.15%), with no difference in incidence between routine NCJ (n =5 ;1 .16%) and selective TJ (n =1 ;1 .06%). Median rate of feeding at time of diagnosis was 105 ml/h (range, 75-125 ml/h), and diagnosis was made at am edian of 6d ays (range, 4-18 days) postoperatively.A ll patients developed abdominal distension, hypotension and tachycardia in the 24 hb efore re-exploratory laparotomy.F ive patients died and one patient survived.CONCLUSIONS The understanding of the pathophysiology of NOSBN is still rudimentary; nevertheless, its 1% incidence in the present study does call into question its routine postoperative use especially in those at high risk with an open abdomen, planned repeat laparotomies or marked bowel oedema. Patients should be fully resuscitated before initiating any enteral feeding, and feeding should be interrupted if there is any evidence of feed intolerance.

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“…[32][33][34][35] In most reports were suggested that EN may play a central role in bowel ischemia ( Table 1). [32][33][34][35][36][37][38][39][40] The pathogenesis of ischemic changes of gut secondary to EN is multifactorial including intraluminal factors, such as increased energy demands in metabolically stressed enterocytes, intestinal bacterial overgrowth and increased bowel's intraluminal pressure with the subsequent reduction in gut perfusion. In AP patients who have hypovolemia, increased capillary permeability, splanchnic hypo perfusion and possible reperfusion injury after initial treatment, they surly may have additional mucosal damage after enteral feeding.…”

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confidence: 99%

Nutritional Support of Patients with the Abdominal Compartment Syndrome during Severe Acute Pancreatitis

Bezmarević¹,

Panisic-Sekeljic²

2016

Pancreas Open J

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Short CommunicationThere is growing evidence in the literature that development of Abdominal Compartment Syndrome (ACS) in patients with Severe Acute Pancreatitis (SAP) has a strong impact on the course of disease. Incidence of ACS in patients with SAP is around 20%. The mortality rate in patients who developed ACS during SAP is 49%, while it is 11% in patients without this complication. The development of organ failure in SAP is in correlation with the presence of intra-abdominal hypertension which can deteriorate already compromised pancreatic perfusion and perfusion of gut in early stages of SAP. The latter leads to the alteration of gut functioning with consequent reduced possibility for enteral feeding. Enteral Nutrition (EN) facilitates gut motility and alleviates bacterial translocation, but in patients suffering from ACS during course of SAP could aggravate bowel ischemia. Parenteral nutrition is required as nutritional support in ACS, but it may increase bacterial translocation and deteriorate gut functioning. Since in the literature data there still have not had recommendations regarding nutritional support of patients with ACS during course of SAP, including optimal time for initiation, duration and amount of specific nutritional regiment, in this short review we have tried to give insight into problems in nutritional support in those patients. This should fortify the interest of physicians to make additional research in order to support further strategies for the more optimal nutritional support of patients with this lethal complication.The abdominal compartment syndrome (ACS) is well described entity which importance in various clinical conditions has been recognized in the last two decades. It is defined as a state of serious organ dysfunction resulting from sustained increase in Intra-Abdominal Pressure (IAP).1 There is growing evidence in the literature data that the development of ACS in patients with severe form of acute pancreatitis (SAP) has strong influence on the course of disease.2-5 The incidence of Intra-Abdominal Hypertension (IAH) in patients suffering from SAP is approximately 70%, while ACS can be found in up to 27% of patients with this form of AP.3,4,6,7 When we add to this a mortality rate of 49% in patients with SAP and ACS, 5 it is clear that IAH and ACS have become an issue of concern in patients with AP. In addition, it was recently mentioned that the number of patients with AP and this complication has increased, but still there have not had standard recommendations for interventional treatment of patients who develop ACS during SAP.8 The step-up approach for conservative treatment of ACS was proposed several years ago.9 However, the appropriate interventional procedure, including surgical technique, and optimal time for reacting in the treatment of AP patients suffering from this serious condition is still debated.From a metabolic point of view, SAP is characterized by nitrogen waste and protein catabolism with negative nitrogen balance and secondary malnutrition.10 Similarl...

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Nonocclusive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection

Cited by 153 publications

References 18 publications

Surgery for Acute Pancreatitis

Surgery for Acute Pancreatitis

Non-Occlusive Small Bowel Necrosis in Association with Feeding Jejunostomy After Elective Upper Gastrointestinal Surgery

Nutritional Support of Patients with the Abdominal Compartment Syndrome during Severe Acute Pancreatitis

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