Intussusception: a Rare Complication After Feeding Jejunostomy; a Case Report

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.

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

“…Minor complications - leakage, dislocation, superficial infection, tube occlusion - make up the vast majority of occurrences[9]. Severe complications are exceedingly rare but can be life-threatening, including small bowel necrosis, intestinal torsion, and intussusception[42-44]. Patients who suffer more serious complications related to their jejunostomy tubes often are unable to tolerate enteral feeding; nearly 20% of patients with feeding tubes still required some period of TPN administration, with 7% directly attributable to tube feeding intolerance or complications[45].…”

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

“…Additionally, feeding through sites distal to the pylorus is associated with decreased risks of certain complications such as aspiration and dehydration. 23 Although we found that inpatient resource utilization is not higher in patients with j-tubes, it is possible that patients with j-tubes may utilize outpatient resources and emergency department (ED) care more frequently. Kidane et al found that feeding tube-related problems were the most common cause (39%) of returning to the ED within the first year after esophagectomy.…”

A Rare Complication of Feeding Jejunostomy: Murky Waters of the Surgeons

“…Its diagnosis is difficult as initially it does not interfere with feeding habits of patient and with advanced disease, there are signs and symptoms of obstruction, i.e. vomiting, pain abdomen and inability to pass faeces and flatus [ 9 ]. The exact mechanism for occurrence of JTI is unknown; however, many mechanisms have been proposed - tip of the tube acting as a lead point, tube-induced inflammatory reaction causing hypertrophy of the mucosa which can form the lead point, retrograde peristalsis of jejunum due to vomiting and injecting force during feeding and reduced mesenteric fat in poorly built patients which allows free movement of intestine [ 9 ].…”

“…vomiting, pain abdomen and inability to pass faeces and flatus [ 9 ]. The exact mechanism for occurrence of JTI is unknown; however, many mechanisms have been proposed - tip of the tube acting as a lead point, tube-induced inflammatory reaction causing hypertrophy of the mucosa which can form the lead point, retrograde peristalsis of jejunum due to vomiting and injecting force during feeding and reduced mesenteric fat in poorly built patients which allows free movement of intestine [ 9 ]. Our patient was of thin built secondary to decreased intake due to previous corrosive acid intake so there was minimal fat in the abdominal cavity, allowing free movement of bowel loops.…”