Long term complication of feeding jejunostomy – small bowel volvulus

Abstract

Introduction: Feeding jejunostomy (FJ) is a lifesaving procedure on many occasions in patients requiring long term nutritional assistance. It is associated with many short and long term complications. Small bowel perforations, small bowel volvuli with infarction, intraperitoneal leaks and intussusception are well reported complications of FJ. Here we present a case report of FJ giving rise to small bowel volvulus. Case report: An elderly male patient of 71 years with underlying systemic hypertension, diabetes mellitus, and thoracic aortic aneurysm with aortoesophageal fistula underwent feeding jejunostomy for long term feeding purpose. Feeding went on well for almost a year. He had a second intravascular procedure for type 1 endoleak. Four months following this he developed an episode of severe colicky abdominal pain associated with vomiting. He was evaluated with CECT abdomen which showed the possibility of mesenteric volvulus with small bowel obstruction at distal ileal level. Patient underwent emergency exploratory laparotomy and untwisting of mesentery with redoing of FJ distal to the previous site of FJ. There was no bowel compromise. He developed severe hypokalemia post operatively which required intra venous potassium infusion and ventilator support. With all supportive management patient continued to deteriorate and succumbed.