A Rare Case of Anterograde Gastroduodenal Intussusception Caused by Migrated Percutaneous Endoscopic Gastrostomy Feeding Tube

Elghezewi, Abdelwahap; Hammad, Mohamed; Mohamed, Mujtaba; Chirico, Peter; Frandah, Wesam

doi:10.14740/jmc4101

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…On CT imaging, gastric intussusception is typically represented as a target-like mass. The concentric bowel wall thickening causes this characteristic layering effect [ 6 ]. Furthermore, the lead point can be found most distal to the intussusception.…”

Section: Discussionmentioning

confidence: 99%

Gastrostomy Exchange With Displacement Into the Jejunum

Mazzorana,

Arif,

Huang

2024

Cureus

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A 54-year-old female with a gastrostomy tube presented with persistent nausea, vomiting, and abdominal pain. On physical examination, the gastrostomy tube was completely advanced into the abdominal cavity with only the external retention ring and hub on the exterior. The first step in the workup was obtaining a scout radiograph. This imaging was appropriate to show the location of the gastrostomy catheter which was overlying the left upper quadrant. The distal tip was heading in the direction of the left lower quadrant. The course of the gastrostomy catheter did not follow the expected direction of the duodenal C-loop. Proceeding forward, contrast was injected through the existing catheter which showed opacification of the jejunal bowel loops. The patient could now be properly diagnosed with gastroenteric intussusception and proper measures could be taken. Following the injected contrast showing jejunal opacification, a stiff Glidewire was advanced through the existing catheter all the way into the jejunum. Deflation of the balloon and removal of the catheter caused an almost instantaneous change in the course of the Glidewire to the more conventional path following the course of the duodenal C-loop. A sheath was then advanced over the wire which was now shown crossing the midline in the proper gastroduodenojejunal course. The final step was to advance a new 22-French MIC gastrostomy catheter over the Glidewire. The contrast was then injected to demonstrate proper opacification of the rugal folds and gastric fundus. The patient reported an immediate resolution of symptoms and was later discharged.

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Section: Discussionmentioning

confidence: 99%

Gastrostomy Exchange With Displacement Into the Jejunum

Mazzorana,

Arif,

Huang

2024

Cureus

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“…Few case reports have shown antegrade gastroduodenal intussusception, coinciding with distal migration of the balloon tip feeding catheter. [ 13 , 14 ] Others have shown cases of retrograde intussusception, coinciding with a repositioning attempt of a distally migrated balloon tip catheter. [ 3 , 4 , 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…case reports have shown antegrade gastroduodenal intussusception, coinciding with distal migration of the balloon tip feeding catheter. [13,14] Others have shown cases of retrograde intussusception, coinciding with a repositioning attempt of a distally migrated balloon tip catheter. [3,4,6] It has been suggested that loose fixation of the feeding tube onto the abdominal wall could result in migration of the balloon tip.…”

Section: Discussionmentioning

confidence: 99%

Retrograde jejunoduodenogastric intussusception associated with fully functioning nonballoon nasojejunal feeding catheter: A case report

Lee

2024

Medicine

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Rationale: Retrograde jejunoduodenogastric intussusception refers to invagination of distal small intestine into the stomach. It is extremely rare. It is often associated with displaced feeding catheter in which its balloon tip migrates past the gastric pylorus. The intussusception is triggered by retraction of migrated catheter. It is often accompanied by feeding intolerance or catheter malfunction. This report describes a distinctive case of retrograde jejunoduodenogastric intussusception associated with a fully functioning nonballoon nasojejunal tube. Patient concern: A 19-year-old female was presented with repeated vomiting and abdominal distension for 5 days. Diagnosis: An abdominal computerized tomography revealed retrograde jejunoduodenogastric intussusception causing air/fluid-filled gastric distension. Immediate endoscopic examination revealed a loop of small intestine, protruding through the pylorus. Progressed ischemia of the migrated small bowel loop was confirmed. Interventions: At laparotomy, a jejunal loop migrating into the duodenum and stomach at the level of the ligament of Treitz was noticed. After manual reduction of migrated bowel, 2 segmental resections of necrotic segment were performed. A feeding jejunostomy was constructed in the proximal jejunum. Outcomes: Enteral feeding through the surgically constructed feeding jejunostomy was started on the 5th operative day and the patient was discharged on the 16th postoperative day. Lessons: When a patient under tube feeding exhibits abrupt intractable gastroesophageal reflux with a sign of catheter migration, we must consider the possibility of catheter-related intussusception. Having a fully functioning feeding catheter with nonballoon tip does not preclude retrograde jejunoduodenogastric intussusception.

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“…A retrospective study of PEG-J tubes placed using endoscopic clips and surgical sutures found that 7% of all tube placement was complicated by migration [10]. Anterograde migration rarely occurs when sutures anchoring the tube in place erode through the skin, leading to tube dislodgement [11]. Physiologic peristalsis subsequently pushes the tube more distally into the small bowel and, in some cases, can even get into the colon [12].…”

Section: Discussionmentioning

confidence: 99%