Direct endoscopic percutaneous jejunostomy (DPEJ) was first described by Shike et
al. 1987 [1] and since then has become increasingly popular [2]. Successful placement is achieved in up to 72 % of patients. Immediate complications
such as bowel perforation and serious bleeding have been reported in up to 22 % of
patients [3]. Currently, reports of complications during replacement of DPEJ are lacking. We
report two cases of intestinal perforation related to the removal and replacement
of DPEJ.
The first case was that of a 61-year-old man with recurrent aspiration, lung abscess,
and bronchiectasia who had an uncomplicated insertion of DPEJ for long-term enteral
nutrition. His clinical outcome improved significantly after 6 months and the DPEJ
was no longer required. He was referred for DPEJ removal. The second case was that
of a 71-year-old lady treated for neck cancer, who received long-term enteral nutrition
via a percutaneous endoscopic gastrostomy (PEG) for 3 years. She suffered recurrent
aspiration pneumonia and the PEG was changed to a DPEJ. After 9 months, she was referred
for DPEJ replacement.
In both cases the DPEJ was removed using the manual traction technique, but the bumper
was disrupted and was not retrieved. Due to concerns about small-intestinal obstruction,
it was decided to retrieve the bumper endoscopically. Unfortunately, both patients
developed signs of an acute abdomen after endoscopy. Abdominal radiography showed
free gas under the diaphragm. A laparotomy was performed in both patients and the
perforation at the site of the DPEJ insertion was repaired. A surgical jejunostomy
was inserted in the female patient. In conclusion, we strongly recommend that enteroscopy
should not be performed once the DPEJ has been removed from the stoma, and if the
internal bumper becomes disrupted, it should be left to pass spontaneously.
Endoscopy_UCTN_Code_CPL_1AH_2AI
