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Jejunal Volvulus Around Gastrostomy Tube: An Exceptional Complication in Cerebral Palsy

Challenging differential diagnosis, Management of emergency care, Rare disease

Hind S. Alsaif, Ali Hassan ORCID logo, Hassan Alsaleem, Osamah J. Refai, Khaled Awary, Faten Alaqeel, Raed Alsulaiman

Saudi Arabia Department of Radiology, King Fahd Hospital of The University, Imam Abdulrahman Bin Faisal University Al-Khobar, Al-Khobar, Saudi Arabia

Am J Case Rep 2021; 22:e932075

DOI: 10.12659/AJCR.932075

Available online: 2021-06-22

Published: 2021-08-04


#932075

BACKGROUND: Cerebral palsy may be accompanied by gastrointestinal disorders. Percutaneous endoscopic gastrostomy (PEG) tube placement is an increasingly performed procedure in these patients. While PEG tube feeding can result in weight gain and a decrease in aspiration episodes, this insertion of a PEG tube is not without complications. Specifically, intestinal volvulus following PEG tube insertion is an exceedingly rare complication.
CASE REPORT: A 34-year-old man with cerebral palsy was brought to the emergency department with a history of recurrent vomiting. He had a history of PEG tube insertion 2 months prior to his presentation. The physical examination was non-contributory. Abdominal computed tomography was suggestive of an intestinal volvulus around the PEG tube. Subsequently, the patient underwent an exploratory laparotomy, which confirmed the diagnosis and enabled successful management. Unexpectedly, the patient suffered cardiac arrest 5 days following the operation. Cardiopulmonary resuscitation was performed with pharmacological intervention and defibrillation in accordance with the advanced cardiac life support guidelines. He recovered successfully and was discharged after a 4-day observation.
CONCLUSIONS: Clinicians should have a high index of suspicion for small bowel volvulus in patients who had a PEG tube inserted, along with intestinal obstruction. Furthermore, caregivers should be educated to recognize the early signs of intestinal obstruction and seek medical attention, since a delay can result in fatal outcomes.

Keywords: Cerebral Palsy, Gastrostomy, Volvulus of Midgut



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