Preventing Retrograde Jejunoduodenogastric Intussusception as a Complication of a Long-Term Indwelling Gastrostomy Tube

Govednik, Cara M.; Cover, Joylin; Regner, Justin L.

doi:10.1080/08998280.2015.11929179

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…Hence, during placement of the PEG tube, it is important that the positioning disc is secured to the skin and the tube be secured to the positioning disc. If the gastrostomy tube is not anchored appropriately, there is a risk of migration, intussusception, and necrosis of the small bowel [8]. In our case, it is believed that the PEG tube may not have been anchored securely enough, giving rise to this complication.…”

Section: Discussionmentioning

confidence: 87%

“…Previous case reports described retrograde jejunogastric intussusception causing small bowel obstruction due to PEG tubes, as the tube can migrate forward into the jejunum and act as the lead point [8]. Although the underlying mechanism of intussusception is not entirely understood, it has been hypothesized that if the external bolster on the gastrostomy tube was not properly fixed, it might allow for the tube to migrate away from the abdominal wall and to slide forward through the gastrostomy tract into the duodenum aided by the propelling forces of normal peristalsis.…”

Section: Discussionmentioning

confidence: 99%

“…Although generally considered safe, PEG tube placement can be associated with many potential complications, including, but not limited to, intestinal trauma, hepato-splenic injury and gastro-colo-cutaneous fistula [7]. Moreover, gastroduodenal intussusception may rarely occur with associated substantial morbidity and mortality [8].…”

Section: Introductionmentioning

confidence: 99%

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Anterograde Gastroduodenal Intussusception: A Rare but Lethal Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

Alomari¹,

Al‐Omari²,

Hitawala

et al. 2019

Cureus

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Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the methods of providing enteral nutrition support and is often used in critically ill patients. There are several complications of PEG tube placement, including intussusception. Jejunojejunal and retrograde jejunoduodenogastric intussusception are well-documented complications of PEG tube placement. Here we describe the case of a 25-year-old female who was diagnosed with anterograde gastroduodenal intussusception with the PEG tube acting as a lead point. Our case is unique as, to the best of our knowledge, there are no documented cases of PEG tube-related anterograde gastroduodenal intussusception. The reported patient was found to have extensive gastric pneumatosis and portal venous gas concerning for acute ischemia. Such cases warrant immediate surgical intervention. However, in our case, the patient's family opted for comfort care measures.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anterograde Gastroduodenal Intussusception: A Rare but Lethal Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

Alomari¹,

Al‐Omari²,

Hitawala

et al. 2019

Cureus

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show abstract

“…Severe long-term complications are rare. Govednnik, Cover and Regner 19 reported a severe case of retrograde jejunoduodenogastric intussusception. In the case reported herein, a minor long-term complication occurred represented by the dislodgment of the feeding tube, followed by a major complication, which was the false path during the replacement of a new tube.…”

Section: Discussionmentioning

confidence: 99%

Feeding tube replacement: not always that simple

Silva

Lederman

Rocha

et al. 2015

ACR

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Although surgical gastrostomy is not a technically troublesome surgery, the procedure may be accompanied by unfavorable outcomes. Most complications occur early in the post-operative period and include feeding tube dislodgment, stomal infection, peritonitis, and pneumonia. The authors report the case of an 83-year-old man who underwent a surgical gastrostomy because of a swallowing disorder after an ischemic stroke. Nine months after the procedure, the feeding tube dislodged and a new tube was inserted with a certain delay and with some difficulty, causing a false path and consequently an intrabdominal abscess after diet infusion. The outcome was fatal. The authors call attention for meticulous care with the insertion of feeding tubes and advise the performance of imaging control to assure its precise positioning.

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“…In adults, the main risk factor for intussusception is prior surgery or intervention, and idiopathic intussusception is uncommon, occurring in 8-20% of cases. 2 Adults typically present with non-specific symptoms, and 90% have an associated lead point. 3 Diagnosis is often difficult, and abdominal CT is the gold standard diagnostic test in adults, while ultrasound the diagnostic standard in children.…”

Section: Case Reportmentioning

confidence: 99%