Knot formation in the feeding jejunostomy tube: A case report and review of the literature

Duodenal Decubitus Ulcer Caused by Percutaneous Endoscopic Transgastric Jejunostomy Tube

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.

Study of Feeding Jejunostomy as an Add on Procedure in Upper Gastrointestinal Surgeries

Jejunostomy is usually indicated as an additional procedure during major surgery of upper digestive tract to administer enteral nutrition in post-operative period. Complications associated with it can be mechanical, infectious, gastrointestinal or metabolic. The aim of the study was to evaluate safety of post-operative feeding jejunostomy in different types of major upper gastrointestinal surgeries. It was a prospective study conducted during the period between August 2009 and September 2011. Post-operative cases of major upper gastrointestinal surgeries who receive jejunostomy feeds were included in the study. Sampling was done by convenient method with sample size of 50 cases. Post-operatively, patients were monitored according to standard orders of enteral nutrition. Total calorie and protein intake through feeding jejunostomy was calculated regularly, and complications were assessed in terms of frequency, type, duration, management, and final outcome in different types of upper gastro intestinal surgeries. Analysis was done using chi square test with the help of statistical package SPSS vers.13. P < 0.05 was considered as significant. Complications observed were gastrointestinal -8 (16 %), mechanical -6 (12 %), infectious -4 (8 %) and metabolic -4 (8 %). Duration of complications ranged from 1 to 7 days (mean, 4 days). All types of complications observed during study were less severe and could be managed by simple measurements. Haemoglobin, serum albumin and weight of the patient at the time of discharge were improved for all patients when compared to pre-operative values. All patients received target calories and proteins through feeding jejunostomy. Considering benefits of enteral feeding via jejunostomy tube with minor and acceptable complications, we conclude that feeding jejunostomy is a preferred route of nutritional administration in those who undergo major upper gastro intestinal surgeries.

[Acute intussusception on jejunostomy tube: a rare cause of intestinal obstruction]

L'invagination intestinale aiguë (IIA) secondaire à une cause inhabituelle est une complication rare et une urgence abdominale. Elle pose un problème diagnostique et thérapeutique. Nous rapportons le cas d'un patient âgé de 45 ans, qui présentait une sténose bulbaire peptique résistante au traitement médical. Le patient a été opéré avec présence en per opératoire d'un estomac de stase, en amont d'une sténose bulbaire infranchissable. Une jéjunostomie d'alimentation à la Witzel a été réalisée vu l’état général très altéré du patient. L’évolution était marquée par l'installation d'une invagination sur sonde de jéjunostomie ayant nécessité une intervention chirurgicale avec des suites simples. L'amélioration de la prise en charge et du pronostic de l'IIA secondaire à une cause inhabituelle nécessitant un diagnostic précoce. Le traitement de cette forme particulière d'invagination est presque exclusivement basé sur la chirurgie.

Removal of a self-knotted feeding jejunostomy tube in a patient with tongue base cancer

The knotting of an intragastric tube is a rare complication, and knotting of a feeding jejunostomy tube is rarer, and the removal or replacement of the tube is difficult. There are many reports on the removal of intragastric knotted tubes, but these methods cannot be applied for the removal of knotted feeding jejunostomy tubes, which do not have a natural orifice as large as the mouth to facilitate the introduction of instruments to correct the complication or remove the knotted tube. This is a stressful situation and doctors have to adopt strategies to resolve this problem safely and effectively in the absence of strong evidence-based knowledge. The author presents the case of a patient with tongue base cancer with a nasogastric feeding jejunostomy tube that knotted during the therapeutic course and describes a simple method to remove the knotted tube using Kelly clamps without additional invasive surgery. A literature review to elucidate methods for the removal of a self-knotted nasogastric tube, especially that occurring in feeding jejunostomy, is also reported.