Abstract
IntroductionNasojejunal feeding tube placement can be achieved by fluoroscopic or endoscopic techniques. Significant complications due to nasojejunal feeding tube placement, such as hydrothorax, duodenal perforation and retroperitoneal emphysema, are very rare. We present a case of massive retroperitoneal emphysema and abscess because of duodenal perforation caused by a kink in a nasojejunal feeding tube.Case presentationA 34-year-old Chinese woman was admitted to our intensive care unit due to hypertriglyceridemia and severe acute pancreatitis. As she suffered from acute respiratory distress syndrome and required mechanical ventilation, a nasojejunal feeding tube was placed by transnasal endoscopic technique. The procedure took place at her bedside. Half a month later, she had a high fever and abdominal distension. An abdominal radiography was performed and showed that the nasojejunal feeding tube was kinking on the third portion of the duodenum and the tip of the nasojejunal feeding tube was inserted into the right retroperitoneum on the second portion of the duodenum.ConclusionWhen a nasojejunal feeding tube is placed through the transnasal endoscopic technique, an abdominal radiography should be used to confirm the tube's position and indicate if it is kinking or beyond the ligament of Treitz.
Highlights
Nasojejunal feeding tube placement can be achieved by fluoroscopic or endoscopic techniques
When a nasojejunal feeding tube is placed through the transnasal endoscopic technique, an abdominal radiography should be used to confirm the tube's position and indicate if it is kinking or beyond the ligament of Treitz
We report a case of massive retroperitoneal emphysema and an abscess caused by a duodenal perforation that resulted from a kink in a nasojejunal feeding tube (NJT)
Summary
Enteral nutrition (EN) via a nasojejunal feeding tube (NJT) is a rational and acceptable method of nutritional support in patients with severe acute pancreatitis (SAP) [1-3]. We report a case of massive retroperitoneal emphysema and an abscess caused by a duodenal perforation that resulted from a kink in a NJT. An abdominal radiography was performed and showed that the NJT was kinking on the third portion of the duodenum. The duodenum was not visualized when meglumine diatrizoate was injected via the right drainage catheter (Figure 2). Meglumine diatrizoate was injected via the NJT and showed that the tip of the NJT was inserted into the right retroperitoneal abscess on the second portion of the duodenum (Figure 3). This demonstrated that the duodenal perforation was caused by the NJT. The recovery course was smooth and EN via the NJT was started five days after the surgical procedure
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