Dumping syndrome in the intra-thoracic stomach
Sinha, S.; Padhy, A.K.; Chattopadhyay, T.K.
Tropical Gastroenterology Official Journal of the Digestive Diseases Foundation 18(3): 131-133
1997
ISSN/ISBN: 0250-636X PMID: 9385867 Document Number: 474612
This report presents the conclusions of a Joint FAO/WHO Expert Committee convened to evaluate the safety of various food additives and contaminants, with a view to recommending acceptable daily intakes for humans, and to prepare specifications for the identity and purity of food additives. The first part of the report contains a general discussion of principles governing the toxicological evaluation of food additives and contaminants, including flavouring agents, and the establishment and revision of specifications, with comments concerning limits for arsenic, lead and heavy metals. The toxicological significance of proliferative lesions of the adrenal medulla in rats fed polyols and other poorly digestible carbohydrates is also discussed. A summary follows of the Committee's evaluations of toxicological data on various specific food additives (dodecyl, octyl and propyl gallate, glycerol ester of wood rosin, ethyl esters, isoamyl alcohol and related esters, allyl esters, alitame, konjac flour, benzyl acetate, benzyl alcohol, benzaldehyde, benzoic acid, the benzoate salts, and sucrose acetate isobutyrate) and the contaminants aflatoxins. Annexed to the report are a table summarizing the Committee's recommendations for acceptable daily intakes of these substances, changes in the status of specifications and further toxicological studies required, and toxicological data on the ethyl and isoamyl esters considered. A retrospective review of patients undergoing feeding jejunostomy (FJ) was undertaken in order to evaluate procedure related complications and their impact on final outcome. Ninety six patients had FJ at the department of Surgical Gastroenterology, SGPGIMS from January 1989 to December 1995. FJ as an adjunct was performed in 89 patients with predominantly oesophageal (n = 62) and pancreatic surgery (n = 17). Seven patients had FJ as the only procedure. Fifteen patients (15.2%) had complications related to FJ. Minor complications (7.2%) included dislodgement (n = 3), blockage of the tube (n = 2) and pericatheter leak (n = 2). Major complications (8.3%) which needed surgical intervention were, detachment of the jejunostomy from the abdominal wall (n = 3), leak into the peritoneal cavity (n = 3), jejunal perforation by the tip of the catheter (n = 1) and peritonitis after removal of the tube (n = 1). Procedure related mortality was 3.2%. FJ should not be treated as a minor procedure and due attention to the technical details is required in its performance, otherwise it may well become the cause of a poor result following a very successful major operation.