PULMONARY ASPIRATION COMPLICATING INTRAOPERATIVE SMALL-BOWEL DECOMPRESSION - A CASE-REPORT AND LITERATURE-REVIEW

When conservative management of intestinal obstruction fails, the surg eon has two operative choices for decompression: the open procedure wi th enterotomies and suction and the closed procedure consisting of ret rograde stripping and nasogastric suction. A previously undocumented c omplication of the latter procedure-pulmonary aspiration-is reported i n a 20-year-old man with small-bowel obstruction. Practical modificati ons to the technique of small-bowel decompression are suggested. They include feeding the nasogastric tube into the distal duodenum, using a wider bore tube, inserting an esophageal balloon before extubation, u sing a nasogastric tube with suction throughout extubation and, immedi ately postoperatively, making a more conscious effort to remove all ga stric contents before extubation, and milking the contents distally th rough the ileocecal valve.