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LETTER TO EDITOR
Year : 2012  |  Volume : 28  |  Issue : 4  |  Page : 540

Anesthesiologist to surgeons' rescue: An off label use of choledochoscope


Department of Anaesthesia and Intensive Care, Govind Ballabh Pant Hospital, New Delhi, India

Date of Web Publication4-Oct-2012

Correspondence Address:
Shiba Aggarwal
Department of Anaesthesia and Intensive Care, Govind Ballabh Pant Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.101959

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How to cite this article:
Aggarwal S, Kumar M, Uppal R, Choudhuri AH. Anesthesiologist to surgeons' rescue: An off label use of choledochoscope. J Anaesthesiol Clin Pharmacol 2012;28:540

How to cite this URL:
Aggarwal S, Kumar M, Uppal R, Choudhuri AH. Anesthesiologist to surgeons' rescue: An off label use of choledochoscope. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2019 May 27];28:540. Available from: http://www.joacp.org/text.asp?2012/28/4/540/101959

Sir,

The passage of nasogastric tube (NGT) through an esophageal stricture is a challenge. Strategies suggested to facilitate its passage include generous lubrication; chilling the tube; grasping the thyroid and lifting anteriorly; neck flexion and extension maneuvers; using two fingers in the mouth to facilitate passage of the tube; and direct visualization by laryngoscope, endoscope [1] and glidescope [2] . We used an innovative method of passing the NGT in an urgent situation when all other methods of passing the NGT were unsuccessful.

A 30-year-old man with esophageal strictures at C7 and D6- D11 levels following accidental corrosive ingestion was posted for abdominal coloplasty and colonic pull up. After surgical exposure, extensive adhesions of ascending and transverse colon with the stomach were observed. The stomach was extensively scarred and unsuitable for pull up. During mobilization and dissection the vascular integrity of the required colonic segment was compromised despite adequate measures to prevent bowel ischemia by the application of warm towels and delivery of 100 % oxygen. All measures to harvest the required segment of colon for transposition proved unsuccessful.

We attempted to pass a 12Fr and 10Fr Ryle's tube (RT) but failed to negotiate it through the stricture. Esophageal intubation with a 5.5 mm ID endotracheal tube was attempted, but it failed. A 5.0 mm ID ETT was successfully passed beyond the upper stricture but a 3.4 mm pediatric fibrescope could not be negotiated through this tube. A 2.5 mm OD choledochoscope (Karl Storz GmbH and Co. KG, Tuttlingen) was passed beyond the stricture. The presence of light channel and maneuverability of its tip facilitated its passage. Gastrostomy was done and 10Fr RT was pulled up retrograde, tied by a thread to the choledochoscope, and brought out through the mouth.

A guide wire was inserted through the RT into the esophagus, which was pulled out and serial dilatations done over the guide wire. A 16Fr RT could easily pass antegrade over it. In the end, the gastrostomy was closed, colonic resection and anastomosis was done and patient's trachea extubated.

 
  References Top

1.Der Kureghian J, Kumar S, Jani P. Nasogastric tube insertion in difficult cases with the aid of a flexible nasendoscope. J Laryngol Otol. 2011; 125:962-4.   Back to cited text no. 1
[PUBMED]    
2.Moharari RS, Fallah AH, Khajavi MR, Khashayar P, Lakeh MM, Najafi A. The GlideScope facilitates nasogastric tube insertion: a randomized clinical trial. Anesth Analg. 2010; 110:115-8.  Back to cited text no. 2
[PUBMED]    




 

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