P3374 - Retrograde Jejunoduodenogastric Intussusception in a Patient With Percutaneous Endoscopic Gastrostomy Tube Presenting With Complete Gastric Outlet Obstruction

Abhishek Goel, MD, Nicole Ebalo, DO, Sanjeev Slehria, MD
Cape Fear Valley Health, Fayetteville, NC

Introduction: Retrograde jejunoduodenogastric intussusception is an extremely rare condition that, based on available literature, has primarily been linked to replacement of percutaneous endoscopic gastrostomy (PEG) tubes or retraction of migrated PEG tubes.

Case Description/Methods: We are describing a case of a 67 year old male with a chronic PEG tube that presented with severe abdominal pain and septic features including tachycardia, tachypnea and leukocytosis along with severe lactic acidosis. Computed tomography (CT) imaging showed significant gaseous and fluid distension of stomach with abnormal appearance of proximal small bowel. Subsequent endoscopic visualization showed inner PEG tube balloon adjacent to a large mass of prolapsed intestine, likely duodenum, in the gastric pylorus and antrum with complete gastric outlet obstruction. The bowel loops showed cyanosis, congestion and other signs of possible nonviability. Non-surgical endoscopic intervention to reduce this intussusception was unsuccessful with subsequent consult to the General Surgery team to explore surgical options. Given patient’s comorbid conditions and poor prognosis, family decided to proceed with comfort care measures for him with subsequent death in the next few hours.

Discussion: This is a rare case of a retrograde jejunoduodenogastric intussusception with most cases described previously linked to the placement/replacement or migration of an indwelling PEG tube. This patient also had a chronic PEG tube with tube hypermobility noted in prior documentation, allowing for the possibility of tube migration and bedside repositioning as a contributing factor to his presentation. Unlike previously reported cases, this patient had failure of endoscopic interventional attempts due to irreducible, severely prolapsed small intestine. Given patient was a poor surgical candidate, he was ultimately switched to comfort care measures by family with subsequent demise a few hours later. This case emphasizes the mortality risk of retrograde jejunoduodenogastric intussusception arising from complications like acute complete gastric outlet obstruction, intestinal incarceration and ultimately strangulation. Hence, we would like to stress on the need for further investigation into underlying etiologies and pathophysiological mechanisms in order to facilitate timely recognition and intervention.



Disclosures:


Abhishek Goel, MD, Nicole Ebalo, DO, Sanjeev Slehria, MD. P3374 - Retrograde Jejunoduodenogastric Intussusception in a Patient With Percutaneous Endoscopic Gastrostomy Tube Presenting With Complete Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.