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Surgical Endoscopy

, Volume 30, Issue 7, pp 3133–3137 | Cite as

Creation of a neopylorus after pyloric exclusion using a “double-endoscope” technique

  • Alexander T. Gibbons
  • Nicholas E. Bruns
  • Reinaldo Garcia
  • Matthew J. Wyneski
  • Todd A. PonskyEmail author
Dynamic Manuscript
  • 200 Downloads

Abstract

Objective

Pyloric exclusion may be implemented in the setting of a high-grade duodenal or pancreatic injury. After exclusion, the pylorus should spontaneously open in 3–6 weeks. However, we present the case of a critically ill 17-year-old male with a gunshot wound to the abdomen that underwent stapled pyloric exclusion with gastrostomy and jejunostomy tube placement who did not achieve pyloric patency after 5 months, and describe an innovative “double-endoscope” technique to correct it.

Methods

A gastroscope was inserted through the mouth into the stomach, and an endoscope was inserted retrograde through the jejunostomy site to the duodenum. The closed pylorus was seen from both ends with transillumination. A needle knife was pushed through the membrane with clear visualization from the contralateral side. A balloon dilation catheter was then passed over a guidewire, and the neopylorus was sequentially dilated. A gastrojejunostomy tube was placed to ensure patency of the neopylorus. Postoperative imaging showed no evidence of leak or pneumoperitoneum. Serial endoscopic dilations were performed every 1–4 weeks to prevent restricturing.

Results

The patient recovered well. After the first follow-up endoscopic dilation, he was eating a regular diet and had no retained food products. After four endoscopic dilations, the patient remained symptom free and the pylorus was widely patent. His gastrostomy and jejunostomy tubes were removed.

Conclusions

Here we presented a rare complication of pyloric exclusion and an innovative approach that used a “double-endoscope” technique and serial endoscopic dilations to establish and maintain a neopylorus, avoiding the morbidity of a major surgical procedure.

Keywords

Endoscopic balloon dilation Pyloric exclusion Neopylorus 

Notes

Compliance with ethical standards

Disclosures

Dr. Ponsky is the owner of GlobalCastMD. Mr. Gibbons, Dr. Bruns, Dr. Garcia, and Dr. Wyneksi have no potential conflicts of interest.

Supplementary material

Supplementary material 1 (MP4 255169 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Alexander T. Gibbons
    • 1
    • 2
  • Nicholas E. Bruns
    • 1
  • Reinaldo Garcia
    • 3
  • Matthew J. Wyneski
    • 3
  • Todd A. Ponsky
    • 1
    Email author
  1. 1.Department of Pediatric SurgeryAkron Children’s HospitalAkronUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA
  3. 3.Department of Pediatric GastroenterologyAkron Children’s HospitalAkronUSA

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