[A 94-year-old woman with nontuberculous mycobacterium who developed small intestinal intussusception associated with a percutaneous endoscopic jejunostomy tube].
We report a 94-year-old woman, who underwent percutaneous endoscopic Jejunostomy (PEJ) tube feeding for enteral nutrition, developed the intussusception of the small intestine. She suffered from nontuberculous mycobacterium (NTM), and her lung inflammation deteriorated due to aspiration pneumonia and malnutrition. Because of old age, dysphagia, esophageal hiatus hernia, gastro-esophageal reflux and her bedridden condition due to severe osteoporosis, oral nutritional supplementation is nearly impossible. To reduce the aspiration risk, we chose PEJ instead of percutaneous endoscopic gastrostomy (PEG) as the route of tube feeding. Six months after the placement of a PEJ tube, aspiration pneumonia was diagnosed and she was readmitted to our hospital. During hospitalization, she had sudden diarrhea, vomiting, and lower abdominal pain. Abdominal CT scan and radiographs using contrast medium showed small intestinal intussusception related to the PEJ tube. We observed the clinical course without performing surgery, pulling it back towards the stomach and placing an ileus tube, because the small intestine was not completely obstructed. Two months later, although she suffered from aspiration pneumonia once more, she remained in a stable condition without further intervention so that she could move to aother hospital. Recently PEJ has been expected to prevent aspiration pneumonia, but we believe that it can be a risk factor for intussusception. Although the PEJ can be a good parenteral nutrition route for frail elderly with dysphagia, we need to consider possible complications including intussusception.
Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo.
Masaki
M
Ishii
Mitsutaka
M
Yakabe
Shinji
S
Teramoto
Yumiko
Y
Oike
Sumito
S
Ogawa
Katsuya
K
Iijima
Masato
M
Eto
Hiroshi
H
Yamamoto
Yoko
Y
Hanaoka
Yasuhiro
Y
Yamaguchi
Masahiro
M
Akishita
Yasuyoshi
Y
Ouchi
D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007421:Intestine, Small; D007443:Intussusception / Q000209:etiology*; D007582:Jejunostomy / Q000009:adverse effects*; D009162:Mycobacterium avium; D011015:Pneumonia, Aspiration / Q000150:complications; D014397:Tuberculosis, Pulmonary / Q000150:complications*