Journal of the Royal Society of Medicine Volume 71 January 1978

33

Use of the Bruecke tube for intestinal decompression: preliminary communication' F I Tovey chM FRCS Basingstoke District Hospital, Park Prewett, Basingstoke, Hampshire, RG24 9NA

There are several requirements for a satisfactory tube for preoperative small bowel decompression. It needs to be flexible, to have a lumen large enough not to be blocked by food particles, to have terminal holes only to decompress the distended loops as it is advanced, to have an air vent to avoid a build up of high negative pressure, and to be long enough to decompress the whole length of the small intestine. The Bruecke tube, which I have been using since 1954, meets the first four requirements, but occasionally is not long enough to reach the whole length of the small intestine, from the duodenojejunal flexure to the terminal ileum. A modified version of the tube (Aldington Laboratories) is long enough for all patients (Figure 1).

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~~~Figure 1. Modified Bruecke tube

The original Bruecke tube was designed with an inner tube on the sump drain principle. This was inclined to become blocked and it was found better to use the outer tube without its inner tube. Use of the tube is indicated in low small-bowel obstruction. In high small-bowel obstruction one can usually milk the contents back into the stomach and aspirate them through a Ryle's tube. 1 Paper read to Section of Surgery, 6 April 1977

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Journal of the Royal Society of Medicine Volume 71 January 1978

Purse String

Figure 2. Enterostomy tube being attached to end of Bruecke tube brought out through small incision in the terminal ileum.

Figure 3. Enterostomy tube introduced retrogradely as far as the duodenojejunal flexure.

It is often useful to decompress the small bowel as the first stage of the operative procedure, before dealing with the cause of the obstruction. The distended intestines should be gently delivered on to the abdominal wall. A length ofjejunum close to the duodenojejunal flexure is emptied between intestinal clamps and the tube is introduced through a purse-string catgut suture which is tightened in a half knot held in artery forceps. The air vent tube is left open lying over a kidney dish in case it leaks, and the theatre nurse holds a pair of artery forceps ready to clamp it when increased pressure is needed. The distal clamp is then removed. The assistant slowly introduces the tube further, while the surgeon telescopes the whole length of the intestine over it. After decompression the tube is slowly removed, the assistant keeping the dirty extruded portion from the sterile towels. As the terminal holes approach the purse-string sutures the nurse clamps the air vent tube to increase the negative pressure, and a tape swab is put under the point of exit. As the tube is finally removed the purse string is tied and the tube itself is placed in a bucket. The assistant changes gloves and the purse-string suture is buried with a layer of interrupted thread sutures. With the intestine collapsed it is much easier to deal with the cause of the obstruction. When dealing with a postoperative obstruction with multiple kinking and adhesions which might indicate a Noble's plication, an alternative is to do a retrograde intubated enterostomy. The enterostomy tube not only serves to keep the bowel decompressed, but also acts as a splint, preventing kinking in the same way as a Noble's plication. It is best introduced retrogradely from below upwards, so that it can be withdrawn from above downwards in stages as the bowel recovers. The Bruecke tube as it is withdrawn can be used to introduce the enterostomy tube (Figures 2 & 3). After decompression of the small intestine, suturing of the abdominal wall is much easier and the postoperative course is much smoother than when the bowel is left distended. There is usually a quick return of peristalsis and the patient makes a rapid recovery. Acknowledgement: The modified Bruecke Decompression Tube is manufactured by Aldington Laboratories Limited, Mersham, Ashford.

Use of the Bruecke tube for intestinal decompression: preliminary communication.

Journal of the Royal Society of Medicine Volume 71 January 1978 33 Use of the Bruecke tube for intestinal decompression: preliminary communication'...
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