Acute Pancreatitis: A Complication of Jejunostomy Tube

Case Report

Austin J Clin Case Rep. 2017; 4(2): 1117.

Acute Pancreatitis: A Complication of Jejunostomy Tube

Ansari J, Anwar S and Agrawal S*

Department of Gastroenterology, Wright State University Boonshoft School of Medicine, USA

*Corresponding author: Agrawal S, Department of Gastroenterology, VA Medical Center, Wright State University,4100 W 3rd St, Dayton, OH 45428, USA

Received: January 10, 2017; Accepted: March 30, 2017; Published: April 10, 2017


We have seen cases in the past where gastrostomy tube migration resulted in pancreatitis by obstruction of the sphincter of Oddi. We report a case of a 60-year-old male who presented to the hospital for malfunctioning jejunostomy tube. Patient had elevated lipase and liver enzymes on presentation. Endoscopic retrograde cholangiopancreatography confirmed extrinsic compression of ampulla of Vater by jejunostomy without filling defects in the biliary tree. After removal of the jejunostomy tube patient felt significantly better and was ultimately discharged.

Keywords: Acute obstructive pancreatitis; Jejunostomy tube; Common Bile Duct (CBD)


Feeding tubes is the preferred root for long term feeding of patients who cannot be fed orally [1]. Acute Obstructive Pancreatitis (AOP) caused by gastrostomy tube migration and Sphincter of Oddi obstruction has been described in a few case reports previously. We describe a case of an elderly nursing home resident who presented with acute pancreatitis caused by extrinsic compression of Ampulla of Vater by a Jejunostomy Tube (JT). A comprehensive literature review was performed using medline and pubmed which revealed that no case thus far has been reported. This case serves to educate the importance of early recognition and management of this unusual complication.

Case Presentation

A 60 year-old male nursing home resident was sent to the hospital for evaluation of a malfunctioning JT. JT was placed earlier in the year for prolonged feeding after patient sustained a traumatic brain injury. Patient was non-verbal at baseline after his injury. His vital signs at the time of admission were normal. Abdominal exam was soft, non tender and JT flushed appropriately; however, some tension was noted when the tubing was withdrawn into the attachment device. Labs on admission revealed amylase 1519, lipase 971, AST 184, ALT 442, alkaline phosphatase 749, total bilirubin 1.0, and direct bilirubin 0.4. A CT scan without contrast was performed which revealed intrahepatic ductal dilatation, Common Bile Duct diameter (CBD) of 10 mm, and mild fat-stranding surrounding the pancreas. Gallbladder was normal without cholelithiasis. Endoscopic Retrograde Cholangiopancreatography was performed and the JT was found compressed across the ampulla with associated ulceration. An attempt to cannulate the CBD was unsuccessful. The JT was removed after balloon deflation. An endoscopic sphincterotomy was then performed and occlusion cholangiogram did not reveal any filling defects. Patient’s liver function test abnormalities gradually improved over the next few days and he was discharged back nursing home (Figure 1,2 and 3).