IS Case 602: J tube malposition in the terminal ileum

Katherine Kaproth-Joslin, MD

Imaging Sciences URMC

Imaging Sciences URMC 2010
Publication Date: 2011-11-17

History

The patient is a 46-year-old female with persistent diarrhea and weight loss since placement of J-tube 8 months ago.

Jejunostomy is a surgical procedure where a tube is placed in the lumen of the proximal jejunum for the purpose of administering nutrition and medication. Placement of this tube can be placed one of three ways: laparotomy during an open procedure, percutaneous endoscopy, and laparoscopy [1]. In this patient’s case, her jejunal tube had been placed by a Witsel tunnel technique during an open procedure, with the portion of small intestine chosen for tube placement was mistakenly the terminal ileum instead of a jejunal segment. Complications of jejunostomy placement can lead to re-laparotomy [2], as did in this patient, however a review of the literature reveal that a terminal ileum malposition of the feeding tube is a very rare event. Primary complications include leakage at the jejunostomy catheter site, catheter site infection, dislodgement of the tube and spillage of the bowel contents into the abdominal cavity, jejunostomy-related peritonitis, jejunostomy-related mechanical ileus, and occlusion of the catheter [2]. The primary feeding related complications of jejunostomy included: diarrhea, nausea, vomiting, abdominal colic, and abdominal distension [2].

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Venskutonis D, Bradulskis S, Adamonis K, Urbanavicius L. Witzel catheter feeding jejunostomy: is it safe? Dig Surg. 2007;24(5):349-53. PMID: 17785978