A 17-year-old boy was admitted to the surgical ward for insertion of a FJ as his PEG tube was not functioning properly. He had been involved in a road traffic accident at the age of 12 and had suffered diffuse irreversible brain injury that had left him bed-ridden and in a vegetative state. Nutritional issues had been managed successfully for 5 years by means of a PEG tube, until the 'buried bumper' of the tube made feeding difficult. The PEG tube was removed and a FJ tube was inserted via a small laparotomy, 25 cm distal to the duodenojejunal flexure.
Twenty-four hours later the patient was restless and appeared to be distressed. Clinical assessment was limited due to his inability to communicate. A contrast study was performed into the jejunum to rule out any tube-related complications; this was reported as normal. Water infusion was subsequently commenced through the FJ as per protocol.
The patient became tachycardic and pyrexial over the next 24 hours and began to vomit. His white cell count was raised at 20 × 109/litre. Chest auscultation revealed right basal crepitations and a plain anterior-posterior chest X-ray showed right lower lobe consolidation. A diagnosis of aspiration pneumonia was made and he was commenced on intravenous antibiotics. The FJ was left on free drainage.
On the third postoperative day he remained septic in spite of the treatment. Clinical examination showed abdominal distension and tenderness. An urgent computed tomography scan was performed which confirmed right basal consolidation but no leak from the FJ tube and no other bowel abnormality.
As his condition did not improve the decision to explore the abdomen was made on clinical grounds. At laparotomy the tip of the feeding tube was found to be lying outside the jejunal lumen having eroded directly through the wall of the small bowel (Figure ). There was minimal spillage of bile in the peritoneum indicating recent perforation. The FJ was removed and replaced by a new tube positioned distally. The perforation and previous FJ site were closed. The patient was admitted to the intensive care unit postoperatively. He made a slow recovery and was discharged home 3 weeks postoperatively.
Intra-operative photograph demonstrating perforation of the jejunum by the feeding jejunostomy tube.