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Roentgen-ray Examination with the Miller-Abbott Tube

1940; Radiological Society of North America; Volume: 35; Issue: 5 Linguagem: Inglês

10.1148/35.5.521

1527-1315

Ross Golden, Octa C. Leigh, Paul C. Swenson,

Hernia repair and management

Introduction DEFLATION of the gastro-intestinal tract by means of a stomach tube was first suggested, in 1884, by Kussmaul and Cahn (1) as an aid in the management of cases of ileus. For the same purpose Westerman (2) and McIver et al. (3) used the duodenal tube. The technic of duodenal deflation was greatly improved by Wangensteen (4), who introduced the use of continuous suction-syphonage apparatus with the duodenal tube. The result was a diminution in the mortality of acute ileus (Wangensteen and Paine (5), 1933). A series of experiments in small intestinal physiology, in Miller's clinic, requiring intubation resulted in the development, by Abbott, of a double-lumen tube for this purpose, now known as the “Miller-Abbott tube” (Miller and Abbott (6), 1934). The smaller of the two lumens connects with a small perforated metal tip about which is attached a small rubber balloon; through this lumen the balloon can be inflated and deflated by injecting or withdrawing air. Near the end of the larger lumen are three or four holes through which gas and fluid may be aspirated or fluid material injected. Abbott showed that proper inflation of the balloon was necessary, after it had passed into the duodenum, to enable peristalsis to move the tube caudad in the intestine. Abbott and Johnston (7) applied this tube to the treatment, localization, and diagnosis of obstructing lesions of the intestinal tract. The technic of insertion of the tube, as used at the Presbyterian Hospital, has been described in detail by Leigh, Nelson, and Swenson (8). It seems unnecessary to discuss it further here except to remark that a little experience is necessary and that the beginner should not become discouraged during his first attempts. The use of the Miller-Abbott tube in the treatment of both mechanical and paralytic ileus, at the Presbyterian Hospital, has been followed by a striking diminution in the mortality of these conditions. The results in 76 cases have been reported by Leigh, Nelson, and Swenson (9). Suffice it to say here that the mortality for the whole series of 76, including the cases with peritonitis and gangrene of the intestine, was approximately 16 per cent. This includes seven of the early cases in which an unsuccessful attempt to pass the tube was made. In the 69 cases in which the tube passed into the small intestine, the mortality was 5.9 per cent. The mortality in 38 cases of mechanical ileus in which the tube was used, was reduced to 7 per cent. In 50 cases of uncomplicated mechanical and paralytic ileus, there has been one death, a mortality of 2 per cent. The purpose of this communication is to discuss the part played by roentgen methods of examination in the Miller-Abbott tube procedure. Roentgen-ray Examination In process of passing the tube into the duodenum, fluoroscopic aid maybe necessary, but as experience is gained it needs to be used less and less frequently.