Abstract
A nasoenteric feeding tube was inserted into the jejunum of 49-year-old woman with a history of bilateral recurrent laryngeal nerve palsy developing after an operation on the cervical spine. Then, 15 ml of distilled water was pushed into the balloon. Ten days later, the patient presented with hemorrhagic stools and hemorrhagic shock. Abdominal CECT showed a massively congregated small intestine and extravasation of the contrast medium. Owing to the detection of muscular guarding on physical examination, an exploratory laparotomy was performed for suspected peritonitis. We found a small intestinal perforation due to an ulcer, for which primary closure was performed after resection of the ulcer. On the night of the surgery, the patient developed a second bleeding episode, for which we performed coil embolization and resection of the embolized ischemic segment of the intestine. Incredibly, the patient developed a third bleeding episode, and we achieved hemostasis by super-selective coil embolization. Considering the possibility of localized embolization, we observed the patient carefully without laparotomy. Five days after the last embolization, a third laparotomy was performed, with resection of the necrotic ischemic intestinal segment.
We consider that the small intestine was massively congregated because of the balloon, with damage to the microcirculation, resulting in the formation of ulcers.
