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

      case-report
      1 , , 2 , 3 , 1 , 4
      ,
      Cureus
      Cureus
      peg, complications of peg, adult intussusception, gastric outlet obstruction

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          Abstract

          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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          Most cited references14

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          Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review.

          Percutaneous endoscopic gastrostomy (PEG) has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. Although generally considered safe, PEG tube placement can be associated with many potential complications. This review describes a variety of PEG tube related complications as well as strategies for complication avoidance. In addition, the reader is presented with a brief discussion of procedures, techniques, alternatives to PEG tubes, and related issues. Special topics covered in this review include PEG tube placement following previous surgery and PEG tube use in pregnancy.
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            Surgical management of intussusception in the adult.

            Controversy concerning the appropriate surgical management of intussusception in the adult prompted review of the Mayo Clinic's experience with this uncommon entity. During the last 23 years, 48 patients had documented intussusception: 24 instances of intussusception originating in the small intestine and 24 instances of intussusception originating in the colon. Two-thirds of the colonic intussusceptions were associated with primary carcinoma of the colon. Only one-third of the intussusceptions of the small intestine were harbingers of malignancy, and 70% of these lesions were metastatic. Because of these findings, we advocate resection of intussusceptions of the colon without initial surgical reduction, in order to minimize the operative manipulation of a potential malignancy. In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon. Initial reduction, followed by limited surgical resection, is the preferred treatment. Surgical resection without reduction is favored only when an underlying primary malignancy is clinically suspected.
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              Intussusception in adults.

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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                30 March 2019
                March 2019
                : 11
                : 3
                : e4347
                Affiliations
                [1 ] Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
                [2 ] Internal Medicine, The Hashmite University, Al-Zarqa, JOR
                [3 ] Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland , USA
                [4 ] Internal Medicine, East Tennessee State University, Johnson City, USA
                Author notes
                Mohammad Alomari alomarm@ 123456ccf.org
                Article
                10.7759/cureus.4347
                6541164
                31187012
                5de7eeb8-baa1-42fb-8f9e-a6efdaade76c
                Copyright © 2019, Alomari et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 March 2019
                : 29 March 2019
                Categories
                Gastroenterology

                peg,complications of peg,adult intussusception,gastric outlet obstruction

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