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A 79-year-old man was electively admitted for a Whipple's procedure for a pancreatic cancer. Following surgery, he was extubated, but subsequently developed a hospital-acquired pneumonia with multiple organ failure requiring admission to the intensive care unit for organ support. After a protracted period of failed weaning from mechanical ventilation, he was transferred to a regional weaning centre 7 months after the initial operation. Since the surgery, the patient had complained of abdominal bloating and discomfort with distended bowel loops observed on the plain abdominal film. Because of frailty of the patient, a conservative management approach was taken, including high positive extrinsic pressure to enhance lung volume and the use of prokinetics, low-volume enteral feeding, regular aspiration of air from the nasogastric tube, sitting …
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