Document Detail


Colonic ischemia and perforation associated with enteral feeding through an ileal tube.
MedLine Citation:
PMID:  20581326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reported complications of enteral feeding through a jejunostomy include diarrhea, intraperitoneal leaks, bowel obstruction, fistula formation, wound infection, tube occlusion, and other mechanical malfunctions. However, the incidence of these complications is very low, and many physicians prefer to feed their patients by means of a jejunal tube instead of parenteral nutrition. A potentially lethal complication is ischemia of the bowel distal to the site of insertion of the feeding catheter. The described cases of bowel ischemia secondary to enteral nutrition invariably occurred at the level of the jejunum. This report describes an unusual case of perforation of the colon in a patient fed through an erroneously placed feeding catheter in the distal ileum, just proximal to the ileocecal valve. After weeks of continuous and intractable diarrhea and progressive weight loss, the patient developed diffuse colonic ischemia with subsequent free perforation of the left colon and peritonitis. Surgical treatment consisted of placement of a new feeding tube in the proximal jejunum and removal of the old one together with a short segment of small bowel, left hemicolectomy, and end colostomy. The patient tolerated the procedure well, the tube feedings were gradually restarted, and at the 6-month postoperative visit gastrointestinal function was normal. This case illustrates possible complications of an inadvertently placed feeding tube. Not only may it cause unexplained diarrhea and undernutrition, but it may lead to more serious events like colonic ischemia and perforation.
Authors:
Kristof De Brabandere; Boudewijn De Waele; Georges Delvaux
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition     Volume:  25     ISSN:  1941-2452     ISO Abbreviation:  Nutr Clin Pract     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-28     Completed Date:  2010-12-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8606733     Medline TA:  Nutr Clin Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  301-3     Citation Subset:  IM; N    
Affiliation:
Department of Surgery, UZB University Hospital, Brussels, Belgium. Boudewijn.Dewaele@uzbrussel.be
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MeSH Terms
Descriptor/Qualifier:
Aged, 80 and over
Colitis, Ischemic / etiology*,  surgery
Colon / pathology
Enteral Nutrition / adverse effects*,  methods
Female
Humans
Ileum
Intestinal Perforation / etiology*
Intubation, Gastrointestinal / adverse effects*
Jejunostomy / adverse effects
Medical Errors*
Peritonitis / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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