Endoscopy 2013; 45(S 02): E347-E348
DOI: 10.1055/s-0033-1344834
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic removal of a fractured nasojejunal tube in the duodenum

Ajay Vardaan
1  Department of Internal Medicine, King George Medical University, Lucknow, India
,
Arshad Ahmad
2  Department of Surgery, King George Medical University, Lucknow, India
,
Devendra Singh
2  Department of Surgery, King George Medical University, Lucknow, India
,
Ravi Misra
1  Department of Internal Medicine, King George Medical University, Lucknow, India
› Author Affiliations
Further Information

Corresponding author

Ajay Vardaan
Department of Internal Medicine
King George Medical University
Lucknow
UP – 226003
India   

Publication History

Publication Date:
25 October 2013 (online)

 

A 40-year-old man, with no significant history of past illness, presented to our emergency department with classic features of perforation peritonitis. Exploratory laparotomy showed duodenal perforation, which was closed with an omental patch. Before suturing the perforation, however, a nasojejunal tube was inserted for feeding. The postoperative period was uneventful and the patient was allowed oral feeding 1 week later. After 2 weeks, the nasojejunal tube was removed with some difficulty with its distal part missing. Abdominal radiography showed the distal end of the nasojejunal tube retained inside the intestine ([Fig. 1]). Upper gastrointestinal endoscopy showed narrowing of the D1–D2 junction with the proximal end of the fractured part of the nasojejunal tube lying just beyond the junction. We tried to grasp this end of the fractured tube with punch biopsy forceps but failed. We then decided to use a polypectomy snare to grasp the proximal end and the fractured tube was removed successfully ([Fig. 2] and [Video 1]).

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Fig. 1 Antero-posterior X-ray of the abdomen in a 40-year-old man who underwent sutural closure of a duodenal perforation: there is a fractured nasojejunal tube lying inside the duodenum and the jejunum.
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Fig. 2 a The fractured nasojejunal tube being removed endoscopically with a polypectomy snare. b The fractured nasojejunal tube after removal.
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Quality:
Endoscopic removal of fractured nasojejunal tube using a polypectomy snare.

The nasojejunal tube was probably sutured along with the duodenal wall during closure of the duodenal perforation, and thus it fractured during removal. There is little literature on endoscopic removal of such long foreign bodies. Only a few case reports had been published on endoscopic retrieval of sutured, knotted, or fragmented nasogastric tubes from the stomach or the posterior pharynx in humans as well as in animals [1] [2] [3] [4]. Thus, utmost care should be taken while suturing the bowel with any tube inside, however, endoscopic techniques can be used successfully to retrieve broken tubes.

Endoscopy_UCTN_Code_CPL_1AH_2AI


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Competing interests: None


Corresponding author

Ajay Vardaan
Department of Internal Medicine
King George Medical University
Lucknow
UP – 226003
India   


Zoom Image
Fig. 1 Antero-posterior X-ray of the abdomen in a 40-year-old man who underwent sutural closure of a duodenal perforation: there is a fractured nasojejunal tube lying inside the duodenum and the jejunum.
Zoom Image
Fig. 2 a The fractured nasojejunal tube being removed endoscopically with a polypectomy snare. b The fractured nasojejunal tube after removal.
Zoom Image