Gastro-jejunostomy tube related intestinal perforation in an infant presenting incidentally with a splenic abscess

Abstract

Introduction: Gastro-jejunostomy tubes (GJT) are commonly used for enteral nutrition in patients with gastric feeding intolerance, gastroesophageal reflux, and those at high risk of aspiration. Complications are generally minor, however highly morbid complications exist, specifically in younger and smaller infants. Case presentation: A 12 month old male with a history of long gap esophageal atresia presented for management of refractory esophageal stricture and intolerance of enteral feeds. To improve his nutritional status and enteral tolerance, he underwent conversion of his gastrostomy tube to a GJT with fluoroscopic guidance. Eight days later, a computed tomography scan of the chest obtained for preoperative planning incidentally noted a splenic abscess containing the tip of the GJT. The patient was taken to the operating room where diagnostic laparoscopy revealed a small bowel perforation at the ligament of Treitz (LOT), with the tip of the GJT embedded within the spleen. The tube was removed, the abscess was debrided, and the small bowel repaired. He completed a post-operative course of intravenous antibiotics and recovered without further complications. Conclusion: While complications from GJTs are well described, this case uniquely highlights the risk of intestinal perforation from GJT, with a delayed and subtle presentation. We suggest that patients, specifically those under 12 months of age and weighing under 10 kg, be monitored closely for complications post-operatively, and the use of modified GJTs with jejunal limbs employing smaller/thinner feeding tubes that are placed well beyond LOT be strongly considered.

Keywords

• Gastro-jejunostomy
• Complication
• Feeding
• Intestinal perforation
• Splenic abscess