经皮内镜胃造瘘术(PEG)是一种广泛用于吞咽困难和口服摄入不足的患者的手术。虽然PEG提供了许多好处,可能发生并发症。这里,我们介绍了一例不寻常的病例,一例68岁女性在常规PEG换管后出现持续性腹泻.尽管尝试了治疗,她的症状持续存在,促使进一步调查。腹部计算机断层扫描(CT)显示PEG管尖端意外移位到十二指肠中。将导管尖端重新定位到胃中解决了腹泻,患者出院,无复发。腹泻是通过PEG管接受肠内营养的患者常见的胃肠道副作用,通常归因于多种因素。然而,根据我们的知识,这是第一例报道的由PEG管尖端误入十二指肠引起的腹泻病例。患者没有经历肠内准备的任何变化或接受已知引起腹泻的药物。在CT扫描期间偶然发现了管的错位,强调影像学检查在难治性病例中的重要性。虽然以前的报道表明十二指肠和胃喂养之间的腹泻发生率没有显着差异,我们的研究结果表明,在某些患者中,十二指肠中PEG管尖的存在可能导致腹泻.该病例强调了CT成像在诊断PEG喂养个体持续性腹泻原因中的潜在作用。病例的进一步积累是必要的,以确定十二指肠管放置作为PEG手术期间腹泻原因的重要性。总之,本病例报告强调了在通过PEG管接受肠内营养的患者中,认为管错位是导致难治性腹泻的潜在原因的重要性.腹部CT成像的使用在识别这种错位和指导适当的干预方面可能是有价值的。需要进一步的研究来验证这些发现,并探索PEG相关腹泻管理的临床意义。
Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for patients with dysphagia and inadequate oral intake. Although PEG offers numerous benefits, complications can occur. Here, we present an unusual
case of a 68-year-old woman who developed persistent diarrhea following a routine PEG tube exchange. Despite treatment attempts, her symptoms persisted, prompting further investigation. Abdominal computed tomography (CT) revealed the unexpected displacement of the PEG tube tip into the duodenum. Repositioning of the tube tip into the stomach resolved the diarrhea, and the patient was discharged without recurrence. Diarrhea is a common gastrointestinal side effect in patients receiving enteral nutrition through a PEG tube, typically attributed to multiple factors. However, to our knowledge, this is the first reported
case of diarrhea resulting from a PEG tube tip straying into the duodenum. The patient did not undergo any changes in enteral preparation or receive medications known to cause diarrhea. The identification of the tube misplacement was incidental during the CT scan, underscoring the importance of imaging studies in refractory cases. While previous
reports indicate no significant difference in diarrhea occurrence between duodenal and gastric feeding, our findings suggest that the presence of the PEG tube tip in the duodenum may contribute to diarrhea in some patients. This
case highlights the potential role of CT imaging in diagnosing the cause of persistent diarrhea in PEG-fed individuals. Further accumulation of cases is necessary to establish the significance of duodenal tube placement as a cause of diarrhea during PEG procedures. In conclusion, this
case report emphasizes the importance of considering tube misplacement as a potential cause of refractory diarrhea in patients receiving enteral nutrition through a PEG tube. The use of abdominal CT imaging can be valuable in identifying such misplacements and guiding appropriate interventions. Further research is needed to validate these findings and explore the clinical implications for the management of PEG-related diarrhea.