Pub Date : 2019-04-17DOI: 10.1201/9780429190407-45
Paul D. Curtis, M. Ashdown, Kevin Virkler
Percutaneous endoscopic gastrostomy (PEG) has become the primary procedure for the long-term nutrition of patients with swallowing disorders. It has been shown to be an effective method with a lower complication rate than surgical placement [1]. It can be performed in the intensive care unit, but complications may occasionally occur. The estimated incidence of major complications is 8% [2]. Abscess and wound infections are the most frequent complications, but necrotizing fasciitis, colon or small bowel injuries, gastrocolic fistula, duodenal hematoma, liver injury, gastric perforation, and catheter migration have also been described [3]. Unexpectedly, acute hemorrhage following PEG is rarely reported. In the literature, we found only one case report of a fatal retroperitoneal hemorrhage occurring 2 hours after a PEG [4]. In a series of 263 cases, Schurink and colleagues [2] described only two cases of intra-abdominal bleeding. A 59-year-old man was admitted to our hospital with intracerebral hemorrhage. On day 40, a PEG was performed in the intensive care unit using the 'pull' technique as previously described [5]. The needle puncture of the stomach was accomplished only on the second attempt, although the rest of the procedure was completed uneventfully. The material used was the Bard ® Fastrac™ Pull PEG Kit (Bard Access Systems, Salt Lake City, USA). One hour after the end of the procedure, the patient presented a tachycardia (120 beats per minute), with cardiovascular collapse (arterial pressure 70/50 mmHg). Physical examination revealed a distended abdomen. The hemoglobin concentration was 5.5 g/dL. Abdominal echography showed the presence of intraperitonal liquid. An emergency laparotomy was performed, revealing a massive hemoperitoneum due to active bleeding from a small vessel of the minor curvature. X-sutures were applied and the bleeding stopped. A gastrostomy was recreated at the end of surgery. The massive hemoperitoneum we described is a rare complication in relation to its rapidity and its severity. We think that the initial, unsuccessful passage of the needle could have caused the gastric artery branch laceration. Indeed, such a mechanism of injuries has already been suggested as an explanation for a fatal retroperitoneum due to breaches in the splenic and superior mesenteric veins [4]. In the patient we described, prompt recognition could minimize morbidity. Although generally considered safe, PEG can be associated with life-threatening bleeding, especially when multiple needle punctures have been made. It presents with unexplained postprocedure hypotension. Intensivists who are used to performing PEG should be aware of this …
经皮内镜胃造口术(PEG)已成为吞咽障碍患者长期营养的主要手术。已被证明是一种有效的方法，其并发症发生率低于手术放置bb0。它可以在重症监护病房进行，但偶尔会发生并发症。估计主要并发症的发生率为8%。脓肿和伤口感染是最常见的并发症，但坏死性筋膜炎、结肠或小肠损伤、胃结肠瘘、十二指肠血肿、肝脏损伤、胃穿孔和导管移位也被描述为[3]。出乎意料的是，PEG后的急性出血很少被报道。在文献中，我们只发现一例致命的腹膜后出血报告发生在PEG bbb术后2小时。在263例病例中，Schurink和他的同事只描述了2例腹腔内出血。一名59岁男性因脑出血入院。第40天，在重症监护病房使用先前描述的“拉”技术进行PEG。只有在第二次尝试时才完成了胃的穿刺，尽管其余的手术都顺利完成。所用材料为Bard®Fastrac™Pull PEG Kit (Bard Access Systems, Salt Lake City, USA)。手术结束1小时后，患者出现心动过速(每分钟120次)，并伴有心血管衰竭(动脉压70/50 mmHg)。体格检查显示腹部肿胀。血红蛋白浓度为5.5 g/dL。腹部超声显示腹腔内积液。紧急开腹手术，发现由于小弯曲小血管活动性出血导致大量腹膜出血。用x线缝合止血。手术结束后重建胃造口术。我们所描述的大量腹膜出血是一种罕见的并发症，其速度和严重程度。我们认为最初不成功的穿刺针可能导致胃动脉分支撕裂。事实上，这种损伤机制已经被认为是由于脾脏和肠系膜上静脉破裂造成的致命腹膜后损伤的解释。在我们所描述的病人中，及时识别可以减少发病率。虽然PEG通常被认为是安全的，但它可能与危及生命的出血有关，特别是在进行多次针头穿刺时。它表现为术后不明原因的低血压。习惯做PEG的强化医生应该意识到这一点。
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{"title":"Ecological and Human Factors","authors":"D. Decalesta, Michael C. Eckley","doi":"10.1201/9780429190407-2","DOIUrl":"https://doi.org/10.1201/9780429190407-2","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"338 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122077997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-15
D. Decalesta
{"title":"National and Regional Perspectives on Deer Management","authors":"D. Decalesta","doi":"10.1201/9780429190407-15","DOIUrl":"https://doi.org/10.1201/9780429190407-15","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123824122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-14
D. Decalesta
{"title":"Deer and Silviculture","authors":"D. Decalesta","doi":"10.1201/9780429190407-14","DOIUrl":"https://doi.org/10.1201/9780429190407-14","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131119565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-18
D. Decalesta
{"title":"Goals, Objectives, and Management Plans","authors":"D. Decalesta","doi":"10.1201/9780429190407-18","DOIUrl":"https://doi.org/10.1201/9780429190407-18","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"177 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114747190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-43
S. Hamilton, J. Hamilton
{"title":"Hamilton Small Woodlot Case History","authors":"S. Hamilton, J. Hamilton","doi":"10.1201/9780429190407-43","DOIUrl":"https://doi.org/10.1201/9780429190407-43","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124066975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-44
R. Brubaker
{"title":"The Brubaker Small Woodlot","authors":"R. Brubaker","doi":"10.1201/9780429190407-44","DOIUrl":"https://doi.org/10.1201/9780429190407-44","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133833008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1201/9780429190407-16
D. Decalesta
{"title":"Deer Density, Carrying Capacity, and Impact on Forest Resources","authors":"D. Decalesta","doi":"10.1201/9780429190407-16","DOIUrl":"https://doi.org/10.1201/9780429190407-16","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134229959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.1017/cbo9781107340893.004
D. Decalesta
{"title":"Autecology","authors":"D. Decalesta","doi":"10.1017/cbo9781107340893.004","DOIUrl":"https://doi.org/10.1017/cbo9781107340893.004","url":null,"abstract":"","PeriodicalId":186070,"journal":{"name":"Deer Management for Forest Landowners and Managers","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126103007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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