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CASE REPORT |
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Year : 2013 | Volume
: 3
| Issue : 1 | Page : 52-54 |
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Jejuno-illeal intussusception: An unusual complication of feeding jejunostomy
Chandan Chatterjee1, Argha Chatterjee2, Shibajyoti Ghosh1
1 Department of General Surgery, Medical College and Hospital, Kolkata, India 2 Department of Radiodiagnosis, Medical College and Hospital, Kolkata, India
Date of Web Publication | 28-Aug-2013 |
Correspondence Address: Chandan Chatterjee 46 Dr. Jagabandhu Lane Kolkata - 700 012, West Bengal India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2278-9596.117119
Feeding jejunostomy is a procedure of tremendous importance in our day-to-day practice of gastrointestinal surgery. Like any other surgical procedure, it is also associated with some common complications such as pain, infection, intra peritoneal leakage, dislodgment, strangulation, and small bowel necrosis. Small bowel intussusception is a complication of feeding jejunostomy, which is very rare and unique. We report the case of a 30-year-old female who presented with small bowel intussusceptions following feeding jejunostomy. Keywords: Feeding jejunostomy, intussusceptions, Witzel jejunostomy
How to cite this article: Chatterjee C, Chatterjee A, Ghosh S. Jejuno-illeal intussusception: An unusual complication of feeding jejunostomy. Arch Int Surg 2013;3:52-4 |
Introduction | | |
Feeding jejunostomy is an important adjuvant procedure in gastrointestinal surgery. It is a very easy, cheap, and effective way of giving enteric nutrition for patients undergoing major G I surgery. Like other surgical procedures, it is also associated with some complications such as pain, surgical site infection, displacement of feeding tube intraperitoneal leakage. Small bowel intussusception induced by a feeding jejunostomy tube is very rare. We present a case of a 30-year-old lady, who underwent feeding jejunostomy for esophageal perforation and later suffered such a rare complication.
Case Report | | |
A 30-year-old lady was suffering from chronic neck pain. For evaluation she underwent esophagoscopy and an iatrogenic perforation in the thoracic part of the esophagus occurred. The perforation was diagnosed during the procedure and she was referred to our hospital on the next day for further management. On admission, her vitals were stable, hematological parameters were within normal limits except for leukocytosis. Chest X-ray was also unremarkable. She was kept nil per mouth and feeding jejunostomy was done as the margin of the perforation was inflamed for maintenance of nutrition until the definitive repair. Post-procedure period was uneventful. She was tolerating jejunostomy feeding well. Regular follow-up of the patient was carried out by endoscopy to look for resolution of the local inflammation. Four weeks after the procedure she developed colicky abdominal pain with bilious vomiting and was unable to tolerate jejunostomy feeding. On general examination, there was tachycardia and fever. On abdominal examination it was found to be tense with guarding present. There was no obvious lump palpable in the abdomen. Intestinal peristaltic sound was hurried on auscultation. She was advised to stop taking jejunostomy feed and was put on IV fluid. Erect X-ray of the abdomen was unremarkable. Since there was no improvement of her physical condition after 48 hours of conservative management with intravenous fluid and nasogastric decompression, we suspected mechanical small bowel obstruction and planned for an emergency laparotomy. On exploration there was ante-grade jejuno-illeal intussusception just distal to the tip of feeding jejunostomy tube [Figure 1]. The jejunostomy was there in its position. Careful and complete reduction of the intussusception was carried out and the jejunostomy was left in place [Figure 2]. Post-operative period was uneventful, and she was able to tolerate jejunostomy feeding again. | Figure 1: Jejunoilleal intussusception distal to the tip of jejunostomy tube
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| Figure 2: Jejunostomy tube left in place after reduction of the intussusception
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Discussion | | |
Jejunostomy is a very useful procedure where a feeding tube is placed in the jejunum primarily to provide nutrition. There are many techniques use for jejunostomy : l0 ongitudinal witzel, transverse witzel, needle catheter technique, percutaneous endoscopy, and laproscopy. [1]
In clinical practice, the most common complications of feeding jejunostomy can be categorized as mechanical (e.g., tube dislocation, obstruction, or migration of tube), infectious (e.g., cutaneous or intra-abdominal abscesses, aspiration pneumonia, peritonitis), gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea, constipation, and abdominal distension), and metabolic abnormalities (e.g., hyperglycemia, hypokalemia, water and electrolyte imbalance, hypophosphatemia and hypomagnesaemia.). [2],[3],[4],[5],[6],[7] The most life-threatening complication among these are small bowel obstruction, non-obstructing small bowel narrowing, and extra luminal tract or collections. Small bowel intussusception induced by a feeding jejunostomy is a rarely reported complication. [8]
Carucci et al. previously reported four cases of jejujno-jejunal intussusception induced by jejunostomy tube. Only one of them developed small bowel obstruction. [8] Laura et al. reported four patients with similar findings but there were no features of obstruction. Tsung-Hsien Wu et al. once reported a similar case of jejuno-jejunal intussusception induced by jejunostomy tube, which needed operative management as there was small bowel obstruction. [9]
In our case, the patient was tolerating jejunostomy feeding normally in the initial few weeks of post-operative period and developed features of small bowel obstruction later. In these cases there may not be any radiological features of intussusception, as in our case. Intussusception in these cases are usually of ante-grade variety. According to Tsung et al. probable cause of intussusception following jejunostomy may be the force produced by the tube feeding with pump infusion on the jejunostomy tube, which acts as a stent. [9] As per Marinis et al. any pathological lesion in the bowel lumen acts as a lead point which is able to initiate a intussusception. [10] However, the exact etiology and mechanism is unknown.
Conclusion | | |
We report a case of jejujno illeal intussusception induced by a jejunostomy tube, presented as small bowel obstruction and managed successfully by operative intervention. Though rare, possibility of such a complication should be kept in mind when a patient having jejunostomy presents as small bowel obstruction in the post-operative period. Clinical suspicion is very much important as other radiological findings are often elusive. Intussusception induced by jejunostomy may or may not cause an obstruction. In case of obstruction, operative reduction is advocated and resection is avoided, if there is no gangrene. [9] In addition, there is no need to remove the jejunostomy tube and feeding can be continued post-operatively without recurrence.
Acknowledgments | | |
Dr. Utpal Kr Dutta, Principal Medical College and Hospital.
References | | |
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[Figure 1], [Figure 2]
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