Proximal jejunal intussusception associated with a long tube

Abstract

An intussusception of the small intestine in association with a long tube usually occurs in the vicinity of the mercury-filled bag and can be visualized radiographically by instilling barium directly into the tube. On rare occasions, an intussusception develops in the proximal jejunum and is difficult to recognize. We report the fifth and sixth cases of a proximal jejunal intussusception with a long tube in situ and outline a clinical approach that facilitates a prompt, accurate diagnosis. A proximal jejunal intussusception should be suspected if copious bilious vomiting and abdominal pain occur following intubation of the small intestine with a long tube.

Severe type of adult jejunal intussusception caused by long intestinal tube in a patient with intestinal obstruction due to cecal carcinoma

“…After stormy postoperative course, the patient developed severe aspiration pneumonitis and disseminated intravascular coagulation and expired. Intussusception in the adult is an uncommon event, with proximal jejunal intussusception secondary to a long tube, especially a severe type like in the current case, considered relatively rare 1–3. Compared to distal small bowel, the loops of proximal small bowel are not usually telescoped as compactly as distal loops 3.…”

“…In our case, as folds of small intestine may become telescoped over the long tube due to ongoing propulsive peristalsis over severely dilated proximal intestine. Most cases of adult jejunal intussusception are difficult to diagnose, and intestinal resection was frequently needed 1–3. Non-invasive imaging modalities including high resolution CT scan is the key to establish its early diagnosis 3.…”

Clinical characteristics of nasointestinal ileus tube-induced intussusception: three case reports and a literature review

“…Several case reports have described jejunostomy tube-induced intussusception, but fewer cases of intussusception caused by a nasointestinal ileus tube have been published. Four recent reports have described five cases of intussusception induced by a nasointestinal ileus tube 5 – 8 ( Table 1 ).…”

“…The location of the intussusception is usually in the proximal jejunum, most frequently near the anterior balloon of the tube. 5,6 When the obstruction is caused by the intestinal wall lesion itself and not a parenteral factor, intussusception is prone to appear as the tube advances, which may be due to asymmetric peristalsis. 7 Water-soluble contrast X-ray and CT examinations are helpful for making a correct and timely diagnosis.…”

“… 4 However, five cases of intussusception caused by nasointestinal ileus tube placement have been reported since the 1980s. 5 – 8 The symptoms of intussusception caused by nasointestinal ileus tube placement are usually so atypical and uncommon that no general treatment guideline has been established for this type of intussusception. Nevertheless, nasointestinal ileus tubes are being applied increasingly more routinely for adhesive SBO.…”