Enteral Migration of a Pezzer Tube After a Feeding Jejunostomy: Report of a Case

Abstract

We herein report a rare complication of the migration of a feeding jejunostomy tube through the entire intestine. A surgical Stamm jejunostomy was performed in a patient with an unresectable gastric cancer using a 28-F silicone catheter with a mushroom tip (Pezzer catheter). The catheter was suture-fixed to the skin, family members were given instructions regarding tube feeding and tube care, and the patient was discharged to home care. Two months later, he presented because of the "disappearance" of the tube. A clinical examination revealed a mature jejunostomy tract, skin erosion at the site where the suture was placed, and absence of the tube. There were no signs of intestinal obstruction or peritonitis. Abdominal X-ray examination showed the catheter inside the jejunum. The patient was treated conservatively with serial radiographs showing rapid tube migration through the intestine, and the tube was eliminated spontaneously 5 days later. An awareness of this complication and its appropriate treatment is important given the widespread use of enteral nutrition.

A rare case of spontaneous anterograde migration of enteral feeding tube

“…[1][2][3][4][5] The complication of internal tube dislodgment and complete enteral migration is very rare and only a few case reports have been published on this topic till date. Complete enteral migration has been reported with a 28-F silicone catheter with a mushroom tip (Silastic Malecot catheter) 6 and an 18-F Levine's tube. 7 In another report 8 28-F Pezzer catheter was used in a male patient with advanced carcinoma stomach and this catheter had migrated into the intestinal tract.…”

“…Secure fixation of the feeding tube to the skin, special gauze and tape stabilization, use of an external retention disk and a retention ring over the catheter, particularly when Foley's catheter is used, as a feeding tube, may all help to prevent its migration. [5][6][7][8][9] Further, patients who have had a FJ tube placed and are being discharged for the domiciliary care need to be educated well not only regarding the nutritional aspects but also about the care of the FJ tube and associated common complications. Patients should report to the health care providers at the earliest if they notice breakage of the anchoring suture or shortening length of the external portion of the tube to prevent such a mishap.…”

“…3 The procedure is associated with several mechanical, nutritional, metabolic complications and sepsis (Table 1). [4][5][6][7][8][9][10] Among the mechanical complications, tube blockage and dislodgment are well known. The complication of tube dislodgment is more commonly external displacement rather than internal migration.…”

A rare complication of jejunostomy tube: Enteral migration

“…In the literature, this potential complication was described in several case reports, which drew attention to the need for appropriate care of these tubes (4-7). Polychronidis et al (6) reported a nearly identical case that concerned enteral migration of a 28-F Pezzer catheter two months after its insertion. Due to the patient's poor condition, conservative measures including administration of paraffin oil through the new JT were taken and the patient passed the catheter after five days.…”

“…We speculate that inadequate suturing of the tube to the skin and/or skin erosion at the fixation suture site over time in the presence of hyperactive bowel may predispose the distal migration. To overcome this complication, Polychronidis et al (6) recommended the use of an external retention disk and a retention ring over the catheter during the placement of feeding tubes. The use of ampules for plugging the tubes between the enteral feeding periods, as in our case, might complicate the clinical scenario even more, so this technique should be discouraged.…”