Shah Jamil, Shahidullah Abul
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, USA.
Department of Medicine, Henry J. Carter Specialty Hospital and Nursing Facility, New York, New York, USA.
Case Rep Gastroenterol. 2020 Jul 30;14(2):409-414. doi: 10.1159/000508908. eCollection 2020 May-Aug.
Nearly all disease processes worsen with malnutrition. However, providing adequate and optimal nourishment can be challenging in individuals who are not able to eat. Insertion of a gastrostomy tube is a well-established method for providing enteral access for long-term nutritional support. Although enteral tube feedings are generally well tolerated, gastrostomy tube placement is associated with several complications. An uncommon, and often initially misdiagnosed, complication of gastrostomy tube placement is gastric outlet obstruction (GOO), which refers to the clinical outcome of any disease process that mechanically obstructs gastric emptying. GOO is a clinical syndrome characterized by nausea, postprandial nonbilious vomiting, epigastric pain, early satiety, abdominal distention, and insidious weight loss due to mechanical obstruction in the distal stomach, pylorus, or duodenum. Rarely, migration and malposition of a gastrostomy tube can lead to this condition. Therefore, physicians should be aware of GOO as a rare complication of gastrostomy tube placement. Often, simple adjustment of the tube can lead to rapid improvement and resolution of the patient's clinical condition as well as prevent needless medical tests, overly aggressive management, and further complications. Here, we present an interesting case of a woman who developed a GOO after unintended migration of a gastrostomy tube.
几乎所有疾病进程都会因营养不良而恶化。然而，对于无法进食的个体而言，提供充足且优化的营养可能具有挑战性。插入胃造口管是一种成熟的方法，用于提供肠内通路以进行长期营养支持。尽管肠内管饲通常耐受性良好，但胃造口管置入会引发多种并发症。胃造口管置入的一种罕见且常被误诊的并发症是胃出口梗阻（GOO），它指的是任何机械性阻碍胃排空的疾病进程的临床后果。GOO是一种临床综合征，其特征为恶心、餐后非胆汁性呕吐、上腹部疼痛、早饱、腹胀以及因胃远端、幽门或十二指肠的机械性梗阻导致的隐匿性体重减轻。胃造口管极少发生移位和位置不当，可导致这种情况。因此，医生应意识到GOO是胃造口管置入的一种罕见并发症。通常，简单调整胃造口管可使患者的临床状况迅速改善并得到缓解，还能避免不必要的医学检查、过度积极的治疗以及进一步的并发症。在此，我们呈现一例有趣的病例，一名女性在胃造口管意外移位后发生了GOO。
