Gastrojejunostomy junction perforation resulting from Dobhoff tube insertion in a patient with a history of Roux-en-Y surgery: a case report.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Monty Khela, Charles Button, Noureen Asghar, Jalal Dufani, Akshat Sood, Joseph Thirumalareddy
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引用次数: 0

Abstract

Background: Gastrojejunostomy junction perforation is a rare yet critical complication associated with enteral tube placement, presenting unique challenges in patients with a history of Roux-en-Y gastric bypass surgery.

Case presentation: A 63-year-old white female with a complex medical history, including heart failure, atrial fibrillation, stage 4 chronic kidney disease, and prior Roux-en-Y gastric bypass surgery in 2015, experienced a significant decline in her health. She was discharged to a skilled nursing facility after a fall but deteriorated rapidly in the 2 weeks before admission. She presented with symptoms of failure to thrive, abdominal/back pain, inability to eat or drink, constipation, and stool incontinence. Lab tests showed anemia, electrolyte imbalances, and acute kidney injury. Imaging confirmed Roux-en-Y gastric bypass anatomy and a small hiatal hernia. Despite treatment attempts, her condition worsened. Nutrition discussions led to a temporary Dobhoff tube placement, considering her Roux-en-Y gastric bypass history, with plans for a gastrostomy tube. However, Dobhoff tube placement posed challenges, and imaging later revealed perforation near the gastrojejunostomy junction. After consulting with the family, the decision was made to transition the patient to comfort care due to her overall condition. Yearly education of staff about Roux-en-Y gastric bypass anatomy and updated Dobhoff placement protocol was implemented with physician oversight. Further imaging protocol in a patient who had had a Roux-en-Y gastric bypass was updated to include fluoroscopic guidance when endoscopic placement was unavailable.

Conclusions: This case highlights the intricacies of managing patients with Roux-en-Y gastric bypass history and underscores the need for meticulous planning and consideration of anatomical variations when performing procedures involving the gastrointestinal tract and the importance of involving multiple healthcare disciplines in complex decision-making and preventive measures to enhance patient safety in similar cases.

曾接受过 Roux-en-Y 手术的患者因插入 Dobhoff 管而导致胃空肠吻合口穿孔:病例报告。
背景:胃空肠吻合口穿孔是与肠管置入相关的一种罕见但严重的并发症,给有鲁氏胃旁路手术史的患者带来了独特的挑战:一位 63 岁的白人女性病史复杂,包括心力衰竭、心房颤动、慢性肾脏病 4 期,曾在 2015 年接受过 Roux-en-Y 胃旁路手术。她在一次跌倒后被送往一家专业护理机构,但在入院前两周病情迅速恶化。她出现了无法茁壮成长、腹部/背部疼痛、无法进食或饮水、便秘和大便失禁等症状。实验室检查显示她患有贫血、电解质失衡和急性肾损伤。影像学检查证实了 Roux-en-Y 胃旁路解剖结构和小食道裂孔疝。尽管尝试了各种治疗方法,她的病情还是恶化了。考虑到她曾有过 Roux-en-Y 胃旁路手术史,营养讨论后决定为她暂时置入 Dobhoff 管,并计划置入胃造瘘管。然而,Dobhoff 管的置入带来了挑战,后来的影像学检查发现胃空肠吻合口附近有穿孔。与家属协商后,考虑到患者的整体情况,决定将其转为舒适护理。在医生的监督下,对员工进行了有关 Roux-en-Y 胃旁路解剖学的年度教育,并更新了 Dobhoff 置管方案。对曾接受过 Roux-en-Y 胃旁路术的患者的进一步成像方案进行了更新,以便在无法进行内窥镜置管的情况下进行透视引导:本病例凸显了管理有 Roux-en-Y 胃分流术病史的患者的复杂性,强调了在实施涉及胃肠道的手术时需要精心策划和考虑解剖结构的变化,以及让多个医疗学科参与复杂决策和预防措施的重要性,以提高类似病例中的患者安全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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