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Pariyar S, Paudel S, Shrestha A, Gaurav B, Prajapati S, Luitel P. Jejuno-jejunal intussusception following feeding jejunostomy: A case report and literature review. Int J Surg Case Rep 2024; 123:110319. [PMID: 39299198 PMCID: PMC11424809 DOI: 10.1016/j.ijscr.2024.110319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/11/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Feeding jejunostomy is a rare cause of jejuno-jejunal intussusception, with presentations ranging from mild bowel obstruction to severe ischemia or perforation. CASE PRESENTATION A 21-year-old male with a recent history of feeding jejunostomy placement presented with acute upper abdominal pain, bilious vomiting, and inability to pass stool or flatus. Ultrasonography confirmed jejuno-jejunal intussusception, necessitating resection of the affected segment and jejuno-jejunal anastomosis. One year postoperatively, the patient remains asymptomatic with no recurrence. DISCUSSION Review of 17 cases of jejuno-jejunal intussusception post-jejunostomy revealed abdominal pain, vomiting, and abdominal distension as common symptoms. Diagnosis relied on imaging modalities like ultrasound or CT, and surgery was the primary treatment. CONCLUSION This case underscores the importance of suspicion and timely intervention to prevent complications in patients with feeding jejunostomy presenting with obstructive symptoms.
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Affiliation(s)
- Suraj Pariyar
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Nepal
| | - Sujan Paudel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Nepal
| | - Asim Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Nepal
| | - Bishal Gaurav
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Saro Prajapati
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Prajjwol Luitel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Nepal.
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Lee SS. Retrograde jejunoduodenogastric intussusception associated with fully functioning nonballoon nasojejunal feeding catheter: A case report. Medicine (Baltimore) 2024; 103:e37772. [PMID: 38608117 PMCID: PMC11018159 DOI: 10.1097/md.0000000000037772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Retrograde jejunoduodenogastric intussusception refers to invagination of distal small intestine into the stomach. It is extremely rare. It is often associated with displaced feeding catheter in which its balloon tip migrates past the gastric pylorus. The intussusception is triggered by retraction of migrated catheter. It is often accompanied by feeding intolerance or catheter malfunction. This report describes a distinctive case of retrograde jejunoduodenogastric intussusception associated with a fully functioning nonballoon nasojejunal tube. PATIENT CONCERN A 19-year-old female was presented with repeated vomiting and abdominal distension for 5 days. DIAGNOSIS An abdominal computerized tomography revealed retrograde jejunoduodenogastric intussusception causing air/fluid-filled gastric distension. Immediate endoscopic examination revealed a loop of small intestine, protruding through the pylorus. Progressed ischemia of the migrated small bowel loop was confirmed. INTERVENTIONS At laparotomy, a jejunal loop migrating into the duodenum and stomach at the level of the ligament of Treitz was noticed. After manual reduction of migrated bowel, 2 segmental resections of necrotic segment were performed. A feeding jejunostomy was constructed in the proximal jejunum. OUTCOMES Enteral feeding through the surgically constructed feeding jejunostomy was started on the 5th operative day and the patient was discharged on the 16th postoperative day. LESSONS When a patient under tube feeding exhibits abrupt intractable gastroesophageal reflux with a sign of catheter migration, we must consider the possibility of catheter-related intussusception. Having a fully functioning feeding catheter with nonballoon tip does not preclude retrograde jejunoduodenogastric intussusception.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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3
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Nulukurthi TK, Kutikuppala LVS, Kuchana SK, Găman M, Koirala SB, Boppana SH. An extremely rare case of feeding jejunostomy proceeding to intussusception. Clin Case Rep 2023; 11:e7460. [PMID: 37323278 PMCID: PMC10267428 DOI: 10.1002/ccr3.7460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/19/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Key Clinical Message Feeding jejunostomy (FJ) is one of the frequently performed surgical procedures for enteral nutrition, but intussusception a very rare complication with quite challenging clinical outcome. It symbolizes a surgical emergency requiring prompt diagnosis. Abstract Feeding jejunostomy (FJ) is a minor surgical intervention, which might lead to consequences that are potentially fatal. Mechanical issues such as infection, tube dislocation or migration, electrolyte and fluid imbalances, as well as complaints of gastrointestinal tract, are the most frequent consequences. A 76-year-old female, who is a known case of carcinoma (CA) esophagus: Stage 4 with Eastern Cooperative Oncology Group (ECOG) Class 3 presented with complaints of difficulty in swallowing and vomiting. As a part of palliative treatment, FJ is done and patient was discharged on postoperative day (POD) 2. Patient again presented to emergency department after 2 months with complaints of pain abdomen, unable to pass flatus and stools for 2 days. Contrast-enhanced computed tomography was done, which revealed intussusception of jejunum with lead point as tip of feeding tube. Intussusception of jejunal loops is noted 20 centimeters distal to the site of insertion of FJ tube with tip of feeding tube as lead point. Reduction of bowel loops was achieved by gentle compression of distal part and are found to be viable. FJ tube was then removed and repositioned after which the obstruction got relieved. Intussusception is an extremely rare complication of FJ, where the clinical presentation can be likely to the various causes of small bowel obstruction. The fatal complications like intussusception in FJ can be prevented by remembering some technical considerations, such as attaching a 4-5 cm segment of the jejunum to the abdominal wall rather than a single-point fixation and maintaining a minimum distance of 15 cm between the duodenojejunal (DJ) flexure and the FJ site.
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Affiliation(s)
- Taraka Krishna Nulukurthi
- Department of General SurgeryKonaseema Institute of Medical Sciences and Research Foundation (KIMS&RF)AmalapuramIndia
| | | | | | - Mihnea‐Alexandru Găman
- Faculty of MedicineCarol Davila University of Medicine and PharmacyBucharestRomania
- Department of Hematology, Center of Hematology and Bone Marrow TransplantationFundeni Clinical InstituteBucharestRomania
| | - Samrat Babu Koirala
- Nepalese Army Institute of Health sciences College of MedicineKathmanduNepal
| | - Sri Harsha Boppana
- Division of Perioperative Informatics/Department of Biomedical, Informatics/Division of Regional Anesthesia, Department of AnaesthesiologyUniversity of California, San DiegoLa JollaCaliforniaUSA
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Balamurugan S, Mohammed M A, Kadambari D, Nagarajan R. Closed-bowel Loop Obstruction-An Unusual and Forgotten Complication of Feeding Jejunostomy: Case Report. Euroasian J Hepatogastroenterol 2022; 12:92-94. [PMID: 36959986 PMCID: PMC10028707 DOI: 10.5005/jp-journals-10018-1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Feeding jejunostomy (FJ) is done as a part of significant upper gastrointestinal surgical procedures for patients who cannot tolerate enteral feeds. This procedure is related to different mechanical, infective, and metabolic inconveniences. However, closed-bowel loop obstruction following FJ is rare. We report an unusual complication of closed-bowel loop obstruction in the postoperative period of FJ done for a locally advanced carcinoma of gastroesophageal (GE) junction for enteral access in a 67-year-old male patient. This patient required an emergency laparotomy, to forestall exacerbating of abdomen distension which could have led to gastric ischemia and perforation following obstruction. A redo FJ was done, and the patient had an uneventful postoperative recovery. Therefore, surgeons should have high clinical suspicion for a rarer complication like a closed-loop obstruction in a patient with upper abdominal pain and distension without vomiting following FJ. How to cite this article Balamurugan S, Aslam MM, Kadambari D, et al. Closed-bowel Loop Obstruction-An Unusual and Forgotten Complication of Feeding Jejunostomy: Case Report. Euroasian J Hepato-Gastroenterol 2022;12(2):92-94.
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Affiliation(s)
- S Balamurugan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Aslam Mohammed M
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - D Kadambari
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rajkumar Nagarajan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Adult Intestinal Intussusception Caused by the Gastrojejunostomy Tube: An Endoscopically Treatable Phenomenon. Case Rep Gastrointest Med 2021; 2021:4325443. [PMID: 34221519 PMCID: PMC8213475 DOI: 10.1155/2021/4325443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Adult duodenoduodenal intussusception is extremely rare due to the retroperitoneal fixation of the second, third, and fourth parts of the duodenum. A majority of clinically significant intussusception with identifiable etiologies is typically neoplastic with more rare causes including retained food and indwelling enteral tubes, specifically with gastrojejunostomy (GJ) tubes. Herein, we discuss the case of a 23-year-old male who developed duodenoduodenal intussusception upon a PEGJ placement with associated gastroduodenal dilation and telescope phenomenon. To the best of our knowledge, there are no reports of intussusception found to be caused by GJ tubes in the adult population. The reported patient was found to have a 4-cm enteroenteric intussusception without obstruction or ischemia with bowel thickening proximal to the pathology. Although adult intussusception cases are typically managed surgically, we were able to reduce the intussusception via endoscopy due to rapid diagnosis upon presentation and intervention before the bowel wall could be compromised.
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Dutta S, Gaur NK, Reddy A, Jain A, Nelamangala Ramakrishnaiah VP. Antegrade Jejunojejunal Intussusception: An Unusual Complication Following Feeding Jejunostomy. Cureus 2021; 13:e13264. [PMID: 33728200 PMCID: PMC7948317 DOI: 10.7759/cureus.13264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Feeding jejunostomy (FJ) is a simple surgical procedure for enteral nutrition. But it can develop complications that may require re-exploration and can be life-threatening. Common complications include mechanical ones such as tube migration or dislocation, infection, gastrointestinal symptoms and fluid and electrolyte imbalances. However, intussusception is a rare complication of FJ. A 54-year-old gentleman underwent a D2 subtotal gastrectomy with Roux-en-Y gastrojejunostomy with FJ. On the sixth postoperative day, he developed severe colicky pain associated with abdominal distension and bilious vomiting. Ultrasonography and computed tomography revealed a 10-cm long jejunojejunal intussusception with the FJ tube at the center of the intussusception with proximal jejunal loops' distension. The patient was taken up for a re-exploratory laparotomy with manual reduction of the intussusception and a new FJ insertion distal to the previous enterotomy site. The patient had an uneventful postoperative recovery.
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Affiliation(s)
- Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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7
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Jejunojejunal intussusception following jejunostomy closure: A case report. Int J Surg Case Rep 2020; 76:446-449. [PMID: 33207409 PMCID: PMC7599362 DOI: 10.1016/j.ijscr.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intussusception can occur anywhere in the small and large bowel, ileocolic intussusception is the most common type in adult and there are few reported cases of jejunojejunal intussusception. Here we report a case of jejunojejunal intussusception due to an iatrogenic lead point at the feeding jejunostomy closure site. CASE PRESENTATION In 2019 we received a 63-year-old female complaining of abdominal pain, constipation, and repeated vomiting for five days. On physical examination, she was dehydrated, in pain, and had a nasogastric tube that was draining bilious fluid. The abdomen was tender, there was a long midline incision with tension sutures at the lower of incision. CT of the abdomen showed ileoileal intussusception. Proper resuscitation and preoperative preparation were done. During exploratory laparotomy, there was jejunojejunal intussusception. The intussusception was reduced gently and completely. Resection of the lead point segment done with end to end anastomosis. The patient recovered uneventfully and discharged home on the 5th postoperative day. The patient followed up after one and three months with no complications. CONCLUSION During the closure of the feeding jejunostomy site by hand-sewn technique, over invagination of the second (seromuscular) layer of the wall of the jejunum might become so thick at the site of the closure that it acts as a lead point for intussusception. We reported a case of such a scenario.
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8
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Ong AW, Myers SR. Early postoperative small bowel obstruction: A review. Am J Surg 2020; 219:535-539. [DOI: 10.1016/j.amjsurg.2019.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 01/30/2023]
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9
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Zhu L, Zheng YX, Chen KB. Clinical characteristics of nasointestinal ileus tube-induced intussusception: three case reports and a literature review. J Int Med Res 2019; 48:300060519878356. [PMID: 31875743 PMCID: PMC7607050 DOI: 10.1177/0300060519878356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Placement of a nasointestinal ileus tube or long tube for gastrointestinal decompression is a new and effective treatment for small bowel obstruction. Such tubes are associated with very few adverse effects. However, several cases of intussusception caused by a nasointestinal ileus tube have been reported. No general diagnosis or treatment guideline has been established for such a complication. We herein present three cases of intussusception caused by nasointestinal ileus tube placement along with a literature review that summarizes some important clinical characteristics of nasointestinal ileus tube-induced intussusception. A diagnosis of intussusception should be considered if severe abdominal pain and distension recur after insertion of a nasointestinal ileus tube. Computed tomography may assist making the diagnosis, especially in patients with typical features such as the “Target sign,” “Glasses sign,” or “Mickey Mouse sign.” Although nasointestinal ileus tube-induced intussusception is rare, clinicians should give more attention to the risk of this complication.
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Affiliation(s)
- Lin Zhu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yi Xiong Zheng
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Kai Bo Chen
- Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, HangZhou, China
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10
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Alomari M, Alomari A, Hitawala A, Khazaaleh S, Al Momani LA. Anterograde Gastroduodenal Intussusception: A Rare but Lethal Complication of Percutaneous Endoscopic Gastrostomy Tube Placement. Cureus 2019; 11:e4347. [PMID: 31187012 PMCID: PMC6541164 DOI: 10.7759/cureus.4347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the methods of providing enteral nutrition support and is often used in critically ill patients. There are several complications of PEG tube placement, including intussusception. Jejunojejunal and retrograde jejunoduodenogastric intussusception are well-documented complications of PEG tube placement. Here we describe the case of a 25-year-old female who was diagnosed with anterograde gastroduodenal intussusception with the PEG tube acting as a lead point. Our case is unique as, to the best of our knowledge, there are no documented cases of PEG tube-related anterograde gastroduodenal intussusception. The reported patient was found to have extensive gastric pneumatosis and portal venous gas concerning for acute ischemia. Such cases warrant immediate surgical intervention. However, in our case, the patient's family opted for comfort care measures.
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Affiliation(s)
| | - Ahmed Alomari
- Internal Medicine, The Hashmite University, Al-Zarqa, JOR
| | - Asif Hitawala
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland , USA
| | | | - Laith A Al Momani
- Internal Medicine, East Tennessee State University, Johnson City, USA
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11
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Sakthivel H, Sahoo AK, Amaranathan A, Raj Kumar N, Maroju NK. A Surgical Conundrum in Feeding Jejunostomy-Jejunojejunal Intussusception: A Case Series. Cureus 2018; 10:e2233. [PMID: 29713578 PMCID: PMC5919769 DOI: 10.7759/cureus.2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intussusception is a common cause of intestinal obstruction in the pediatric population. Usually, it is primary and benign and can be managed by nonoperative interventions in 80% of the cases. Adult intussusception accounts for only 5% of all cases of intussusception and 1%–5% of all cases of intestinal obstruction. Unlike in the pediatric population, intussusception in adults is usually caused by a pathologic lead point. The initial investigation to diagnose it is an ultrasound abdomen followed by contrast-enhanced computed tomography (CECT) of the abdomen. The placement of an intestinal tube for feeding purposes has been rarely reported as a cause of intussusception. Here, we present a case series of four patients who had jejunojejunal intussusception following the placement of feeding tubes into the jejunum. Three patients were operatively managed and one was managed conservatively.
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Affiliation(s)
- H Sakthivel
- MBBS, Ms Senior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ashok Kumar Sahoo
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nagarajan Raj Kumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nanda K Maroju
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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12
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Dholaria S, Lakhera KK, Patni S. Intussusception: a Rare Complication After Feeding Jejunostomy; a Case Report. Indian J Surg Oncol 2016; 8:188-190. [PMID: 28546717 DOI: 10.1007/s13193-016-0604-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/01/2016] [Indexed: 01/11/2023] Open
Abstract
Feeding jejunostomy (FJ) is a commonly done surgical procedure for enteral nutrition. Intussusception is one of the rare complications of FJ. Clinical presentation may be similar to other causes of small bowel obstruction. Intussusception should be suspected if a patient with jejunostomy tube develops upper gastrointestinal obstructive symptoms, which are relieved by nasogastric tube drainage. CT or ultrasonography (USG) can help to confirm the diagnosis. It can be relieved spontaneously or sometimes requires laparotomy. We have encountered such complication in one patient. The patient developed intestinal obstruction after removal of FJ tube and was diagnosed as having intussusception radiologically. On exploration, intussusception was identified at FJ site for which surgical reduction was done.
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Affiliation(s)
- Shreyas Dholaria
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
| | - Sanjeev Patni
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan India
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Abstract
Obtaining reliable enteral and vascular access constitutes a significant fraction of a pediatric surgeon׳s job. Multiple approaches are available. Given the complicated nature of this patient population multiple complications can also occur. This article discusses the various techniques and potential complications associated with short- and long-term enteral and vascular access.
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Affiliation(s)
- James S Farrelly
- Division of Pediatric General and Thoracic Surgery, Yale Children's Hospital, Yale University School of Medicine, PO Box 208062, New Haven, Connecticut 06520-8062
| | - David H Stitelman
- Division of Pediatric General and Thoracic Surgery, Yale Children's Hospital, Yale University School of Medicine, PO Box 208062, New Haven, Connecticut 06520-8062.
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14
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Lee SY, Lee JC, Yang DH. Early Postoperative Retrograde Jejunojejunal Intussusception after Total Gastrectomy with Roux-en-Y Esophagojejunostomy: A Case Report. J Gastric Cancer 2013; 13:263-5. [PMID: 24511423 PMCID: PMC3915189 DOI: 10.5230/jgc.2013.13.4.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/28/2013] [Accepted: 12/09/2013] [Indexed: 12/17/2022] Open
Abstract
Intussusception is a rare cause of postoperative intestinal obstruction in adults. Many retrograde intussusceptions occur during the period following gastrectomy. A 77-year-old woman visited our hospital because of detected gastric adenocarcinoma. She received radical total gastrectomy with Roux-en-Y esophagojejunostomy. On the fifth postoperative day, she complained of abdominal pain, and we found leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent limb of the jejunojejunostomy. Emergency surgery was performed. Retrograde jejunojejunal intussusception accompanied with a nasojejunal feeding tube was found at the efferent loop of the jejunojejunostomy. No ischemic change was found; therefore, manual reduction and primary repair of esophagojejunostomy was performed. She was discharged without complications on the 23rd re-postoperativeday. We suggest that the nasojejunal feeding tube acted as a trigger of intussusception because there was no definitive small bowel mass or postoperative adhesion. We present our findings here along with a brief review of the literature.
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Affiliation(s)
- Se-Youl Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong-Chan Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Doo-Hyun Yang
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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15
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Krishna S, Prabhu R, Thangavelu S, Shenoy R. Jejuno-jejunal intussusception: an unusual complication of feeding jejunostomy. BMJ Case Rep 2013; 2013:bcr-2013-200219. [PMID: 23814219 DOI: 10.1136/bcr-2013-200219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The jejuno-jejunal intussusception is a rare complication of jejunostomy tube placement. We are reporting a case of 33-year-old man who was suffering from absolute dysphagia due to carcinoma of cricopharynx with advanced metastatic disease, who underwent Stamms feeding jejunostomy as a part of palliative care. After 1 month he presented with colicky type of pain in the abdomen and vomiting. Sonogram of abdomen revealed a target sign and a feeding tube in a dilated jejunum. Abdominal CT proved the sonographic impression of jejuno-jejunal intussusception. He, therefore, underwent exploratory laparotomy and resection and anastomosis of the intussuscepted bowel. New feeding jejunostomy (FJ) was done distally from the anastomotic site. As per the literature this complication has been reported in Witzels jejunostomy. In our case the patient had undergone Stamms jejunostomy with placement of a Ryle's tube. Intussusception should be considered if a patient comes with abdominal pain and vomiting following FJ.
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16
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Furuya Y, Wakahara T, Akimoto H, Long CM, Yanagie H, Yasuhara H. A case of postoperative recurrent intussusception associated with indwelling bowel tube. World J Gastrointest Surg 2010; 2:85-8. [PMID: 21160855 PMCID: PMC2999218 DOI: 10.4240/wjgs.v2.i3.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/12/2009] [Accepted: 11/19/2009] [Indexed: 02/06/2023] Open
Abstract
Intussusception is quite uncommon in adults. We report a rare case of a 76-year-old man with small bowel intussusception induced by two indwelling bowel tubes, the first a jejunal feeding tube and the second an ileus tube. After complete reduction of the first intussusception caused by the jejunal feeding tube and adhesion, re-intussusception occurred due to the postoperative adhesion and ileus tube inserted into the bowel after the previous operation for intussusception. Finally, the part of the jejunum with re-intussusception and adhesion, including the place where the previous reduced intussusception had occurred, was resected. This case is a reminder that when there is no mucosal lesion other than an indwelling bowel tube or a hard adhesion/inflammation around intussusception, the patient should be operated on without delay for resection of the intussusception to prevent re-intussusception, even if the resected bowel is predicted to be long.
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Affiliation(s)
- Yoshitaka Furuya
- Yoshitaka Furuya, Takashi Wakahara, Harutoshi Akimoto, Chu Manh Long, Department of Surgery, Sodegaura Satsukidai Hospital, 5-21 Nagauraekimae, Sodegaura, Chiba 299-0246, Japan
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17
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Ruiz-Elizalde AR, Frischer JS, Cowles RA. Button-loop feeding jejunostomy. J Gastrointest Surg 2009; 13:1376-8. [PMID: 18825465 DOI: 10.1007/s11605-008-0708-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Post-pyloric feeding via a surgical jejunostomy allows for enteral nutrition in patients that cannot receive oral or gastric feeding. Regardless of the technique used to create a jejunostomy, complications such as tube dislodgement, jejunostomy closure, or bowel obstruction can occur. SURGICAL TECHNIQUE We present a simple and efficient jejunostomy technique that does not require a sewn anastomosis and employs an easily exchangeable feeding button.
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Affiliation(s)
- Alejandro R Ruiz-Elizalde
- Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, CHN-201, New York, NY 10032, USA.
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Stylianides NA, Date RS, Pursnani KG, Ward JB. Jejunal perforation caused by a feeding jejunostomy tube: a case report. J Med Case Rep 2008; 2:224. [PMID: 18590544 PMCID: PMC2443370 DOI: 10.1186/1752-1947-2-224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Percutaneous endoscopic gastrostomy and feeding jejunostomy are used for providing long-term nutritional support to patients with neurological disorders. Various mechanical complications of these procedures are described. Case presentation We report a case of a 17-year-old boy with cerebral injury who had a percutaneous endoscopic gastrostomy tube changed to a feeding jejunostomy tube. Twenty-four hours later he developed abdominal pain and became clinically septic. A contrast study through the feeding tube and a subsequent computed tomography scan did not reveal any intra-abdominal pathology. At laparotomy it was discovered that the tip of the feeding tube had perforated through the jejunal wall and was lying outside the lumen. This was successfully treated by re-inserting a feeding jejunostomy tube distally and closure of the perforation and previous FJ site Conclusion We suggest that the threshold for contrast studies and operative intervention should be low in neurologically impaired patients to avoid the delay in treatment of tube-related complications.
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Affiliation(s)
- Nicholas A Stylianides
- Department of Gastrointestinal Surgery, Lancashire Teaching Hospital NHS Foundation Trust, Preston Road, Chorley, Lancashire, UK.
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