Intussusception is an invagination of a segment of the gastrointestinal tract into an adjacent one. Jejunojejunal intussusception is a rare complication of jejunostomy tube placement with an incidence of 1%. We are reporting a case of 35-year-old man who was suffering from severe oral, lesions due to Ingestion of acide agents. He received Witzel jejunostomy for early feeding. Ileus developed postoperatively and plain X-ray of the abdomen showed distended small bowel loop. Abdominal computed tomography revealed target sign as well as the feeding tube in a dilated jejunum and intussusception was diagnosed. Exploratory laparotomy was required due to failure of expectant therapy. Reduction of intussusception was done during exploratory laparotomy. The jejunostomy feeding was continued and the postoperative course was uneventful.
Intussusception is an invagination of a segment of the gastrointestinal tract into an adjacent one. Jejunojejunal intussusception is a rare complication of jejunostomy tube placement [
A 35 year-old man presented to an outside institution for ingestion of acid agent, intentionality of the ingestion was suicidal, esophagogastroduodenoscopy between H12 and H24 findings lIB esophagus and III A stomach to Zargar classification, with severe oral lesions. Witzel jejunostomy was done to allow early feeding. The patient was recovering well after adequate nutritional support via jejunostomy tube feeding; however, vomiting occurred on the 5th postoperative day. After vomiting, colicky pain was relieved, and vomiting continues despite the antiemetic treatment. Plain abdominal X-ray showed a dilated small bowel loop in the left upper abdomen, Due to the persistent intermittent symptoms a CT was performed, Abdominal CT identified a target sign in the left abdomen, and intussusception was diagnosed (
Therefore, and after patient consent, an exploratory laparotomy was performed due to failure of expectant therapy, and a 10 cm long fleshy sausage-like tubular intestinal mass was found at the proximal jejunum, 15 cm distal to the entry of the jejunostomy tube (
Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition [
The common complications of tube jejunostomy described in literature are mechanical (tube dislocation, ob-
struction or migration), infectious (cutaneous or intra-abdominal abscesses, aspiration pneumonia, peritonitis), gastrointestinal and metabolic abnormalities (hyperglycemia, hypokalemia, water and electrolyte imbalance, hy- pophosphatemia, hypomagnesemia) [
Jejunojejunal intussusception induced by jejunostomy tube was first reported in a series of four patients. The four patients had no clinical symptoms found at radiographic examination, and the intussusception resolved without intervention [
The diagnosis of jejunostomy tube-induced intussusceptions is difficult as it may not disturb with tube feeding. Usually diagnosis is arrived on the basis of clinical symptoms and sonography or tomographic scans [
Jejunostomy tube-induced intussusception usually resolves spontaneously but also may require operative intervention. Usually tube-induced intussusceptions are managed by changing the tube to standard or short tube without distal pigtail [
Our patient had obstructive gastrointestinal symptoms, Exploratory laparotomy was required due to failure of expectant therapy. Jejunojejunal intussusception without gangrenous change was identified during the operation, and the jejunostomy tube was still in the normal position. The patient was successfully treated with operative reduction without resection of the small intestine, and he recovered well postoperatively. Although the jejunostomy tube had caused the intussusception, it was not removed during the operation, and no resection of the intussusception was done. This suggests that evacuation of the jejunostomy and resection of the bowel segment of intussusceptions to prevent recurrence may not be necessary except in the case when intussusception was not reducible, gangrenous change, perforation or stenosis. [
Feeding jejunostomy is usually not associated with major complications requiring surgery. Those patients who are having persistent pain and vomiting, a diagnosis of intussusception should be considered, even though rare. Operative treatment will be required in patients having the above persistent symptoms thereby reducing the morbidity and suffering.
The authors report no conflicts of interest.