A68 DISTAL MIGRATION OF A PERCUTANEOUS GASTROJEJUNAL DUODOPA INFUSION TUBE DUE TO BEZOAR FORMATION AT THE JEJUNAL TUBE TIP

Abstract Background Continuous intestinal infusion of levodopa/carbidopa intestinal gel (LCIG) for the treatment of advanced Parkinson’s Disease (PD) leads to less variability in plasma drug levels and improved symptom control. Percutaneous Gastrojejunostomy (PEG-J) tube placement has a high placement success rate; however, delayed tube malfunctions occur in approximately 58% of cases within two years. A rare complication is bezoar formation at the jejunal tube tip. Aims To present a case of bezoar formation at the jejunal tip of a PEG-J tube that caused distal migration of the tube with gastroduodenal ulceration and required surgical extraction. Methods Full chart review was conducted including clinical notes, laboratory results, radiographic imaging, endoscopy reports, and surgical reports. A relevant literature review was conducted. Results A 57-year-old male with severe PD underwent endoscopic guided PEG-J tube insertion for continuous infusion of LCIG; intestinal administration was effective for symptom control. Two years later, he noted that the gastric tube had retracted approximately 15 cm into the stoma without external manipulation of the apparatus. Attempts to externally pull the tube back into position were unsuccessful. The patient underwent Gastroscopy (EGD) with fluoroscopy. Contrast was used to confirm placement of the jejunal tip within the jejunum, but also showed migration of the gastric tip into the duodenum. A gastroscope was used to reposition the gastric tube in the stomach; the jejunal tube was visualized to be under traction. The bumper on the apparatus was re-positioned and external tape was used to further secure the apparatus and prevent migration. A month later the tube had migrated again; repeat EGD showed the jejunal tube to be under traction with some resultant ulceration of the pyloric channel and duodenal bulb where the tube had been pressing against the mucosa. The jejunal tube could not be pulled back and appeared to be fixed distally. A CT scan was obtained to assess for complications and a coiled tip was seen in the proximal jejunum. Surgical extraction of the malfunctioning tube was required. At laparotomy, the coiled tip of the feeding tube was successfully removed via enterotomy. The tube tip had coiled around itself and was encased with food materials, creating a large bezoar that was being pulled distally by peristalsis. The patient subsequently underwent insertion of a new GJ tube for ongoing administration of LCIG and has been doing well since. Conclusions Bezoar formation at the jejunal tip of LCIG PEG-J tubes is a rare complication and can lead to distal migration and traction related gastroduodenal ulceration. Surgical removal may be required. Funding Agencies None

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Rapunzel syndrome: an uncommon tale of a long hairy tail - case report and review of literature

International Surgery Journal ◽

10.18203/2349-2902.isj20214394 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3463

Author(s):

Dinesh Manchikanti ◽

Manisha Aggarwal ◽

Shaji Thomas ◽

Ashish Arsia ◽

Rahul Pusuluri ◽

...

Keyword(s):

Abdominal Pain ◽

Outlet Obstruction ◽

Complete Removal ◽

Normal Mucosa ◽

Psychiatric Evaluation ◽

Surgical Removal ◽

Proximal Jejunum ◽

Behaviour Therapy ◽

Rapunzel Syndrome ◽

Distal Migration

Trichobezoar is a rare clinical entity in which a ball of hair accumulates within the alimentary tract. When the tail of the trichobezoar extends into the small intestine, this condition is called Rapunzel syndrome (RS). A 14-year-old female presented with pain abdomen and vomiting for 2 weeks, and a history of trichotillomania and trichophagia, and an epigastric lump. A contrast enhanced computerized tomography (CECT) of the abdomen showed a grossly distended stomach with a heterogeneous mass containing trapped air with underlying normal mucosa suggestive of trichobezoar, with its tail extending into the proximal jejunum suggestive of RS. During laparotomy, a giant trichobezoar was seen in the stomach with its tail extending beyond the duodenum into the proximal jejunum. The entire specimen was delivered out intact. On follow up, she has no surgical complications, and was on behaviour therapy. Trichobezoars form when ingested hair strands become retained in the folds of the gastric mucosa and becomes entangled, forming a ball too large to exit the stomach. Trichotillomania and trichophagia are seen in many of these patients. Patients present with abdominal pain, vomiting, gastric outlet obstruction, and an epigastric mass. In the case of RS, complete removal without breakage and distal migration is important. RS should be considered as a differential diagnosis in a young girl with abdominal pain, vomiting, anaemia and upper abdominal lump. Early diagnosis prevents complications. Surgical removal is treatment of choice. Trichobezoar often coexists with psychiatric illness. Psychiatric evaluation, counselling and treatment are helpful in preventing recurrence.

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Correct Gastric Tube Placement in Very Low Birth Weight Neonates

Case Medical Research ◽

10.31525/ct1-nct04127773 ◽

2019 ◽

Author(s):

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Gastric Tube ◽

Very Low Birth Weight ◽

Tube Placement

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Success rate of naso-jejunal tube placement influenced by CRRT: possible removal of metoclopramide

Critical Care ◽

10.1186/s13054-021-03652-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Patrick M. Honore ◽

Sebastien Redant ◽

Thierry Preseau ◽

Sofie Moorthamers ◽

Keitiane Kaefer ◽

...

Keyword(s):

Success Rate ◽

Tube Placement ◽

Jejunal Tube

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Effect of Platelet-Rich Fibrin Application on Non-Infectious Complications after Surgical Extraction of Impacted Mandibular Third Molars

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168249 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8249

Author(s):

Grzegorz Trybek ◽

Justyna Rydlińska ◽

Magda Aniko-Włodarczyk ◽

Aleksandra Jaroń

Keyword(s):

Treatment Process ◽

Infectious Complications ◽

Control Group ◽

Surgical Removal ◽

Study Group ◽

Impacted Tooth ◽

Platelet Rich Fibrin ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars

Due to the frequent development of non-infectious complications after surgical removal of the third lower impacted tooth, many techniques are used to reduce their severity. Among them is the technique of applying platelet-rich fibrin to the post-extraction alveolus. The study included 90 consecutively enrolled patients. Eligible patients were randomly assigned to two groups: patients with and without platelet-rich fibrin introduced into the postoperative alveolus. Pain, swelling, trismus, and temperature were evaluated after the procedure. Pain intensity was significantly higher in the control group than in the study group at 6 h, 1, and 3 days after surgery. PRF application did not significantly affect the intensity of swelling. Body temperature was significantly higher in the control group than the study group on day two after surgery. The trismus was significantly higher in the control group than in the study group at one, two, and seven days after surgery. Application of the PRF allows for a faster and less traumatic treatment process. It will enable for speedier recovery and return to active life and professional duties.

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Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial

International Journal of Dentistry ◽

10.1155/2016/8169356 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Hani Arakji ◽

Mohamed Shokry ◽

Nayer Aboelsaad

Keyword(s):

Statistical Significance ◽

Third Molar ◽

Test Site ◽

Surgical Removal ◽

Third Molars ◽

Randomized Controlled ◽

Surgical Extraction ◽

Impacted Mandibular Third Molars ◽

Mandibular Third Molars ◽

Bone Quantity

The purpose of this study was to test the effect of the surgical removal of impacted mandibular third molars using piezosurgery versus the conventional surgical technique on postoperative sequelae and bone healing.Material and Methods.This study was carried out as a randomized controlled clinical trial: split mouth design. Twenty patients with bilateral mandibular third molar mesioangular impaction class II position B indicated for surgical extraction were treated randomly using either the piezosurgery or the conventional bur technique on each site. Duration of the procedure, postoperative edema, trismus, pain, healing, and bone density and quantity were evaluated up to 6 months postoperatively.Results.Test and control sites were compared using pairedt-test. There was statistical significance in reduction of pain and swelling in test sites, where the time of the procedure was statistically increased in test site. For bone quantity and quality, statistical difference was found where test site showed better results.Conclusion.Piezosurgery technique improves quality of patient’s life in form of decrease of postoperative pain, trismus, and swelling. Furthermore, it enhances bone quality within the extraction socket and bone quantity along the distal aspect of the mandibular second molar.

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Safety and effectiveness of dual guidance with video-laryngoscopy and ultrasound in jejunal tube placement in patients undergoing invasive mechanical ventilation

Annals of Palliative Medicine ◽

10.21037/apm-21-139 ◽

2021 ◽

Vol 10 (3) ◽

pp. 3128-3134

Author(s):

Na Wu ◽

Haitao Shen

Keyword(s):

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Video Laryngoscopy ◽

Tube Placement ◽

Jejunal Tube

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Application of Modified Gastric Tube Placement in Patients with Indwelling Gastric Tube

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i6.2702 ◽

2021 ◽

Vol 5 (6) ◽

pp. 84-88

Author(s):

Hua Tang

Keyword(s):

Pain Score ◽

Nasogastric Tube ◽

Research Group ◽

Gastric Tube ◽

Reference Group ◽

Mucosal Injury ◽

Tube Placement ◽

Study Group ◽

Liquid Spray ◽

Nasogastric Tube Placement

Objective: To explore the effect of modified nasogastric tube placement and Rehabilitation New Liquid Spray in patients with indwelling gastric tube. Methods: Eighty-six cases with indwelling gastric tube in our hospital from January 2020 to May 2021 were randomly selected and divided into the reference group and the research group. The reference group was treated by modified gastric tube placement, and the research group was given the Rehabilitation New Liquid Spray intervention. The effect of the interventions on two groups was observed. Results: The incidence of nasal mucosal injury in the research group was lower than that in the reference group, and the incidence of pharyngeal mucosal injury in the research group was lower than that in the reference group (P < 0.05). The pain score of the study group was lower than that of the reference group at 8 h, 12 h and 24 h after replacement, and the incidence of hoarseness, swallowing discomfort and dry oropharynx was lower than that of the reference group (P < 0.05). Conclusion: The application of modified gastric tube placement and Rehabilitation New Liquid Spray intervention in patients with indwelling gastric tube can effectively reduce the nasopharyngeal injury and improve the pain of catheterization.

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Detection of Inadvertent Airway Intubation During Gastric Tube Insertion: Capnography Versus a Colorimetric Carbon Dioxide Detector

American Journal of Critical Care ◽

10.4037/ajcc2006.15.2.188 ◽

2006 ◽

Vol 15 (2) ◽

pp. 188-195 ◽

Cited By ~ 42

Author(s):

Suzanne M. Burns ◽

Richard Carpenter ◽

Cheri Blevins ◽

Sharon Bragg ◽

Mary Marshall ◽

...

Keyword(s):

Carbon Dioxide ◽

Intensive Care Unit ◽

Intensive Care ◽

Mental Status ◽

Gastric Tube ◽

Medical Intensive Care Unit ◽

Tube Placement ◽

Tube Type ◽

Gastric Tubes ◽

Medical Intensive Care

• Background In the medical intensive care unit at the University of Virginia Health System, capnography is used to detect end-tidal carbon dioxide to protect patients from inadvertent airway cannulation during placement of gastric tubes. • Objectives To compare the method in which capnography is used with a method in which a colorimetric carbon dioxide detector is used and to determine what variables affect accurate placement of gastric tubes. • Methods A prospective convenience sample of 195 gastric tube insertions was studied in 130 adult patients in a medical intensive care unit. Standard insertions of gastric tubes (done with capnography) were simultaneously monitored by using a disposable colorimetric device, with a color change indicating the presence of carbon dioxide. • ResultsInsertion variables included tube type (60% Salem sump tubes, 40% soft-bore feeding tubes), route of insertion (71% oral, 29% nasal), mechanical ventilation (81%), and decreased mental status (72%). Carbon dioxide was successfully detected with the colorimetric indicator (within seconds) in all insertions in which carbon dioxide was detected by capnography. When carbon dioxide was detected (27% of insertions), the tubes were withdrawn and reinserted. Carbon dioxide detection during tube placement was significantly associated with nasal insertions (P = .03) and spontaneously breathing/nonintubated status (P=.01) but not with mental status or tube type. • Conclusions A colorimetric device is as accurate as capnography for detecting carbon dioxide during placement of gastric tubes.

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