NEW INSTRUMENTS

New, Improved Nasogastric Duodenal Mercury Tip Sump Tube

For Use in the Management of Intestinal Obstruction

Joseph Hodge, MD, Spartanburg. South Carolina

Various techniques for the management of intestinal obstruction have been documented [I-7]. Paralytic ileus and simple mechanical obstruction can be treated with efficient decompressive tubes [7]. Complete mechanical obstruction requires surgical intervention in order to prevent strangulation, gan- grene and severe metabolic derangement. The author has developed an improved nasogastric duodenal sump tube with a slightly curved mercury-weighted tip that can easily be introduced by the attending physician, house staff or nurse.

Material and Methods

The decompressive tubes (Figures 1 and 2) are 183 and 244 cm in length and size 18 French in diameter, incorpo- rating a 12.5 cm, slightly curved, mercury-weighted tip consisting of a ventral aspirating lumen with a funnel connector to the wall suction and a vent lumen. The vent tube runs along the base of the main lumen, through which air and saline are introduced to remove particulate matter from the aspirating perforations proximal to the weighted tip. The perforations extend 12.5 cm proximal to the tip of the tube. The tube’s prefilled integral mercury-weighted tip (15 g) is radiopaque and assists in roentgenographic visualization. The distal end of the tube incorporates a radiolucent section (0.64 cm) which separates the two ra- diopaque mercury-f&d segments. The radiolucent section, which is proximal to the shorter radiopaque segment at the distal tip of the tube, serves as a helpful guide in locating and positioning the distal end of the tube under fluoros- copy (Figure 1). It is difficult with other conventional ra- diopaque tubes to determine the proximal and distal end

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Requests f& reprints should be addressed to Joseph l-lodge. MD, The Hodgs Building, 864 N. Chuch Street. Spartanburg. South Carollna 29303.

unless one can visualize the air column proximal to the mercury tip. The radiolucent section significantly aids in positioning the tube in the large and small bowel.

Comments

The nasogastric duodenal decompressive tube is indicated in the management of paralytic ileus, partial or complete mechanical obstruction of the small and large bowel, or as a decompressive vent

Flgure 1. Diagram of the tube.

Figure 2. Mercury- wetghted sump tube.

Volume 140, September 1960 475

Hodge

during large and small bowel resection. The tube is used in certain clinical conditions after ventral her- niorrhaphy, gastric resection and cholecystectomy and after multiple abdominal procedures where there is an increased risk of recurrent adhesions and in- testinal obstruction. The tube may also be used to obtain gastrointestinal, biliary and pancreatic se- cretions for diagnostic purposes and can adequately serve as a feeding tube. It is introduced transnasally or orally and in most cases can be passed directly into the duodenum without the aid of fluoroscopy.

On reaching the 26 or 28 inch mark on the tube, the mercury tip will be found in the first and second part of the duodenum. If the aspirating material has a greenish tinge, one can assume that the tip of the tube is in the duodenum. If gastrointestinal secre- tions are clear, the patient is placed on the right side for approximately half an hour and carried to fluo- roscopy, where the mercury tip can be easily passed into the duodenum and jejunum by identifying the radiolucent section proximal to the short mercury segmeut at the tip of the tube; this establishes the exact anatomic position of the decompressive tube. Slack is left in the tube; it is not taped to the nose and is allowed to progress under normal peristaltic movements directly into the small bowel. It should be irrigated every hour by disengaging the funnel from the wall suction and by introducing 15 to 20 cc

of normal saline solution into the main lumen of the tube, followed by 5 to 10 cc of air injected into the air vent. This prevents particulate matter from plugging up the section lumen.

Summary

A new, improved nasogastric duodenal mercury tip sump tube can be introduced simply and efficiently and is especially useful in the management of pa- tients with partial and complete mechanical ob- struction, thus sparing the patient surgical inter- vention and expensive hospitalization.

References

5.

6.

7.

Abbott WO. Indications for the use of the Miller-Abbott tube. N Engl J Med 1941;225:641.

Cantor MO. Mercury: its role in intestinal decompression tubes. Am J Surg 1947;73:690.

Devine JW, Devine JW Jr. Duodenal intubation. Surgery 1953; 33513.

Harris FI. Intestinal intubation in bowel obstruction: technic with new single lumen mercury weighted tube. Surg Gynecol Ob- stet 1945;81:671.

Hodge J. An enterotomy-colotomy decompressor for the treat- ment of intestinal obstruction. Am J Surg 195696428.

Hodge J. The long arm enterotomy-colotomy decompressor in the surgical management of intestinal obstruction. J SC Med Assoc 1964;60:217.

Hodge J. The clinical use of the naso-gastric duodenal mercury tip sump tube in abdominal surgery and in the management of intestinal obstruction. Ann Surg 1978; 187:lOO.

476 The American Journal of Surgery