Siddens Edward David, Al-Habbal Yahya, Bhandari Mayank
General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, Perth, Western Australia, WA 6150, Australia.
World J Gastrointest Surg. 2020 Aug 27;12(8):369-376. doi: 10.4240/wjgs.v12.i8.369.
Post-operative enteral nutrition gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature.
The 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple's procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication.
Enteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality.
术后通过胃管或空肠喂养管进行肠内营养是治疗重症患者或术后患者的常见标准做法。它有一系列自身的并发症，包括梗阻、脓肿形成、坏死和胰腺炎。我们在此报告一例由肠内营养粪石引起的小肠梗阻病例。这是医学文献中胰腺十二指肠切除术后该并发症的第二例记录病例。
一名70岁女性因胰腺腺癌到我院接受胰腺十二指肠切除术（惠普尔手术）。术后第5天，她病情无进展并出现小肠梗阻症状，随后进行了计算机断层扫描，显示为机械性小肠梗阻。此后，她接受了急诊剖腹手术和小肠减压。恢复过程漫长，但最终她出院回家。我们在MEDLINE数据库中检索了1966年至2020年的报告。我们确定了8篇文章，共描述了14例肠内喂养粪石继发小肠梗阻的病例。在这14例病例中，除4例外均发生在上消化道手术后；除1例外在所有病例中，因临床症状恶化均需要进一步手术干预。推测其原因包括pH值变化、胰腺酶和胃动力降低以及阿片类药物的使用。
肠内喂养粪石是肠内营养的一种并发症。尽管发病率很低，但它可导致严重的发病率和潜在的死亡率。
