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Failure of a feeding jejunostomy
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A rare case of a pedestrian fatally injured by a motor vehicle experienced malnutrition due to feeding jejunostomy failure. Small bowel hyperperistalsis complicated the jejunostomy, leading to death.
Area of Science:
- Medical Case Study
- Gastroenterology
- Trauma Surgery
Background:
- A 16-year-old female pedestrian sustained severe head trauma after a motor vehicle accident.
- Initial hospitalization focused on managing severe neurological deficits and associated complications.
Observation:
- A jejunostomy was placed for nutritional support, but the patient experienced persistent feeding difficulties and severe diarrhea.
- Despite interventions, adequate nutritional intake was not achieved, and hyperperistalsis of the small bowel was observed.
Findings:
- Autopsy revealed the jejunostomy catheter bulb had migrated distally, obstructing function.
- The cause of death was attributed to malnutrition secondary to feeding jejunostomy failure, exacerbated by small bowel hyperperistalsis in the context of diffuse brain trauma.
Implications:
- This case highlights a previously undescribed complication of feeding jejunostomy leading to fatal malnutrition.
- It underscores the importance of monitoring jejunostomy function and managing gastrointestinal motility in patients with severe neurological impairment.
Abstract:
A healthy 16-year-old female pedestrian was hit by a motor vehicle. She sustained multiple injuries including severe head injury. She was admitted to hospital unconscious. There was no recovery of neurological function. After a short period of time, a jejunostomy was performed for feeding purposes. The major clinical problem continued to be a feeding difficulty, with profuse diarrhoea occurring. At no stage was it possible to adequately nourish her. Hyperperistalsis was noted whilst in hospital. She died just over three months after admission. Autopsy revealed an emaciated body weighing only 25kg. An upper jejunostomy was still present containing a No. 20 French catheter. The bulb had threaded down the small bowel so that it was situated 25cm proximal to the ileocaecal valve. The small bowel was empty. The cause of death was given as malnutrition due to failure of function of a feeding jejunostomy due to small bowel hyperperistalsis in an individual with diffuse brain trauma. This complication of feeding jejunostomy causing death from malnutrition has not previously been described in the English literature.