MANAGEMENT OF A MIGRATED JEJUNOSTOMY TUBE

Brandon C Dessecker, MD, Safi Haq, MD, D James Smith, MD. Northside Medical Center/ Western Reserve Health Education

Introduction: Enteral feeding accesses are some of the most morbid surgical procedures. Misplacement, dislodgement, clogging, and wound complications are among the most common of these complications. We present a case of a patient who had underwent placement of a feeding jejunostomy secondary to esophageal cancer where the tube migrated after a recent replacement.

Case Report: 59 year old male with a history of esophageal cancer status post esophagectomy and gastric pull through as well as a feeding jejunostomy placement presented to the emergency room after he thought that his feeding catheter had fallen out overnight. He was unable to find the catheter within his home. He recently was seen at another institution after he had his feeding catheter fall out as well. A Foley catheter was placed at the institution in order to allow for feeding access. He underwent abdominal radiography, which demonstrated the catheter in his abdomen (Figure 1), and further underwent computerized tomography (CT) in order to further evaluate the location of the catheter. CT demonstrated the catheter within his terminal ileum and the Foley catheter balloon inflated.

He was admitted with plans to monitor radiography in hopes that the tube would pass into the colon. The following day there was noted to be no movement of the catheter on radiography. Given this, an attempt was made to was made to attempt to deflate the balloon using a percutaneous, CT guided needle, which was unsuccessful. The following day he proceeded to surgery for small bowel enteroscopy, through his jejunostomy, in order to attempt to remove the catheter from proximally. This was also unsuccessful, and required a laparotomy with enterotomy to remove the catheter (Figures 2). In image 2, by the surgeon’s right hand hemorrhage was noted at the small bowel from the attempted CT deflation of the catheter.

Conclusion: While this is a rare complication of a jejunostomy tube, there are several lessons that can be learned. We believe that the Foley catheter balloon was overinflated, which allowed peristalsis to carry it through the small bowel before lodging at the ileocecal valve. While a Foley catheter can be used for maintaining an enteral feeding tract, true feeding tubes have an external bumper, which allows apposition against the abdominal wall and prevent tube migration.