Clin Endosc.  2019 Nov;52(6):616-619. 10.5946/ce.2019.016.

Migration of a Percutaneous Endoscopic Gastrojejunostomy Tube into the Colon with Small Intestinal Telescoping

• Taki S
• Maekita T
• Sakata M
• Fukatsu K
• Maeda Y
• Iguchi M
• Ito H
• Kitano M

• KMID: 2465806
• DOI: http://doi.org/10.5946/ce.2019.016

Abstract

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson's disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.

Keyword

Bezoar; Levodopa/carbidopa intestinal gel; Parkinson’s disease; Percutaneous endoscopic gastrostomy

MeSH Terms

Abdominal Pain
Aged
Bezoars
Colon*
Colon, Ascending
Colonoscopy
Diet
Endoscopy, Digestive System
Female
Gastric Bypass*
Gastrostomy
Humans
Ileum
Intestine, Small
Pyloric Antrum
Surgical Instruments
Ulcer
Vomiting

Figure

• 

  Fig. 1. Esophagogastroduodenoscopy and contrast examination. (A) Endoscopic and (B) contrast examination images of the initial percutaneous endoscopic gastrojejunostomy.

• 

  Fig. 2. Esophagogastroduodenoscopy and computed tomography (CT). (A) Endoscopic image of a longitudinal ulcer extending from the anterior wall of the lower gastric body and (B) duodenum to the ileum end, with shortening of the lesser curvature of the stomach and telescoping of the entire small intestine. (C) and (D) Coronal and horizontal CT images. The tube tip reaches the ileocecum.

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  Fig. 3. Colonoscopy. (A) Colonoscopy image showing a large bezoar, about 6×2 cm2 in size, attached around the tip of the tube, reaching the ascending colon over the Bauhin’s valve. (B) After bezoar removal by forceps. (C) The contrast-enhanced image of the gastrointestinal tract shows telescoping of the small intestine.

• 

  Fig. 4. Scheme for the presumed process of migration of the percutaneous percutaneous endoscopic gastrojejunostomy (PEG-J) tube into the colon with small intestinal telescoping. (A) The normal deployment of the PEG-J tube for the Duodopa® (AbbVie GK, Tokyo, Japan) system. (B) Attachment of food residues around the tube tip. (C) Shortening of the stomach and small intestinal telescoping by long-term excessive traction. (D) Migration of the tube tip into the colon.

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