Gastrojejunostomy Tube Bowel Perforations in Low‐Weight Infants

Abstract

This is a case series in which 3 infants with gastrojejunostomy tube (GJT) insertion developed delayed perforation secondary to pressure necrosis. A review of all patients who underwent a GJT placement in 2013 was performed. Three of these patients developed surgically confirmed perforation secondary to pressure necrosis during this time period; no patients developed perforation at the time of GJT insertion. The indications for GJT insertion for all 3 patients were severe gastroesophageal reflux disease; 2 patients also had recurrent aspiration. The patients were between 9 weeks and 10 months of age at the time of GJT insertion. The site of perforation for all 3 cases occurred just distal to the ligament of Treitz between 48 and 72 hours following insertion. Given our 3 cases of perforation in patients weighing <10 kg, there may be a higher risk of perforation in low-weight patients.

Intussusception Caused by Percutaneous Endoscopic Gastrostomy With Jejunal Extension in Patients With Severe Motor and Intellectual Disabilities

“…PEG-J is useful for patients with chronic intestinal pseudoobstruction chronic pancreatitis and Parkinson's disease (13)(14)(15). The efficacy of PEG-J has also been reported in pediatric patients (5)(6)(7)(8)16). The most common complication of PEG-J is retrograde tube migration.…”

“…PEG‐J is also a useful nutritional route for children with SMID (4). Although PEG‐J is relatively safe, complications have been reported5–8. Serious complications include intussusception, but the incidence of intussusception in children with SMID is unknown.…”

Postpyloric Feeding Access in Infants and Children: A State of the Art Review

“…The JT is a gastrostomy button with either a balloon or mushroom bolster. Primary JTs can be placed using open or laparoscopic surgery, by endoscopy, or by IR (42,43,47,48,(51)(52)(53). The endoscopic approach is performed using balloon or push enteroscopy.…”

Image-Guided Enteral Access and Interventions in Children

“…43 Tubes with small-bore (8-to 9-Fr) jejunal extensions are recommended to prevent this complication, although perforations have been described with both these extensions and low-profile balloon retention tubes. 44,45 Smaller (12-Fr) balloon retention GJ tubes are in development to address this issue. Additionally, the potential for gastric outlet obstruction may be higher with larger diameter balloon retention tubes obstructing the pylorus in younger children, although this has not been reported in the literature.…”

“…The mean number of replacements per year for tube related issues is 2.7 to 9.4. 42,44,46 Tube dislodgement rates are difficult to quantify given variable follow-up intervals; however, may range from 26 to 42%. 41,46 Based on these data and manufacturer guidelines, tubes changes are recommended at a minimum interval of 3 to 4 months.…”