Necrotizing peritonitis following feeding jejunostomy: a rare postoperative complication

Necrotizing peritonitis is a rare, life-threatening complication of peritonitis involving inflammation and necrosis of the peritoneal lining. We report a unique case of necrotizing peritonitis following laparoscopic feeding jejunostomy in a patient with esophageal carcinoma. With a limited number of cases reported due to its rarity, this case highlights the importance of recognition of aberrant postoperative complications and early surgical intervention.

We report the case of a 50-year-old woman with distal esophageal squamous cell carcinoma who underwent laparoscopic feeding jejunostomy on 9 January 2023. She returned to the emergency department on 13 January 2023, with abdominal pain and vomiting. Diagnostic contrast-enhanced computed tomography (CT) revealed portal venous gas, diffuse peritoneal air, and soft tissue emphysema. An emergency laparotomy confirmed necrotizing peritonitis with patchy bowel necrosis and contamination near the jejunostomy site. Despite receiving aggressive medical and surgical management, the patient progressed to multiorgan failure and died on 13 January 2023.

The patient's rapid clinical deterioration with extensive portal venous gas and intraoperative findings of patchy transmural bowel necrosis pointed toward a severe systemic infectious process. While subcutaneous emphysema is usually benign post-laparoscopically, its widespread nature with signs of sepsis in this case hinted more toward a necrotic pathology. CT imaging showed free intraperitoneal air, mesenteric edema, and fat stranding pointing toward bowel necrosis. These findings differentiated from other diagnosis like mesenteric panniculitis.

This case underscores the critical importance of early recognition, CT imaging, and timely surgical exploration in improving survival in such rare postoperative complications.