Ijuin Shinichi, Yano Aika, Nakatani Yukihide, Kaneda Haruki, Ishihara Satoshi
Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN.
Cureus. 2025 May 8;17(5):e83749. doi: 10.7759/cureus.83749. eCollection 2025 May.
Enteral nutrition (EN) is a well-established feeding method for individuals with dysphagia or those with intubation. Although EN tube placement is generally well tolerated, complications can sometimes occur. A 60-year-old male was brought to our hospital after being struck by a container that had slid off the trailer bed. He sustained severe traumatic brain injury, pelvic fracture, and open fracture of the lower leg, for which appropriate treatment was initiated. No abnormalities were identified in other organs on CT. As mechanical ventilation management was continued, EN was administered via an EN tube placed in the duodenal bulb. On day 26, he experienced excessive vomiting and an increase in gastric residual volume (GRV). Despite medication adjustments and reduced feeding volume, only minimal improvement was observed. On day 33, upper gastrointestinal endoscopy revealed significant edematous changes in the duodenal bulb, near the tip of the EN tube, indicating a possible stenosis. The EN tube was repositioned into the stomach, and he was managed with fasting and fluid replacement, leading to a gradual reduction in GRV. As illustrated in this report, the placement of an EN tube in the duodenal bulb - an area located at an acute angle to the descending portion of the duodenum and part of the retroperitoneal space - should be avoided to prevent potential obstruction.
肠内营养（EN）是一种针对吞咽困难患者或插管患者的成熟喂养方法。尽管EN管置入通常耐受性良好，但有时也会出现并发症。一名60岁男性在被从拖车床上滑落的集装箱撞击后被送往我院。他遭受了严重的创伤性脑损伤、骨盆骨折和小腿开放性骨折，并已开始进行适当治疗。CT检查未发现其他器官有异常。由于持续进行机械通气管理，通过置于十二指肠球部的EN管给予肠内营养。第26天，他出现了过度呕吐，胃残余量（GRV）增加。尽管调整了用药并减少了喂养量，但仅观察到轻微改善。第33天，上消化道内镜检查显示EN管尖端附近的十二指肠球部有明显的水肿变化，提示可能存在狭窄。将EN管重新置入胃内，并对他进行禁食和补液处理，导致GRV逐渐降低。如本报告所示，应避免将EN管放置在十二指肠球部（该区域与十二指肠降部呈锐角，是腹膜后间隙的一部分），以防止潜在的梗阻。
