Shirane Kazuki, Mochizuki Kyoko, Sugita Azusa, Tanaka Satoshi, Morishima Rento, Kondo Takafumi, Inagaki Yoshinori, Usui Hidehito, Kitagawa Norihiko, Toyoshima Katsuaki, Shinkai Masato
Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0228. Epub 2025 Jul 19.
Nasojejunal tube placement is a rare cause of small bowel intussusception. It is usually treated with tube removal, but a few cases require surgical reduction. We report a case of small bowel intussusception due to a nasojejunal tube shortly after surgery for ileal atresia, in which surgical reduction was required despite removal of the tube.
A female infant underwent intestinal anastomosis for type III-A ileal atresia on the day of birth. A nasojejunal tube was placed for abdominal decompression until the temporary anastomotic passage obstruction improved. Bowel dilatation was successfully resolved; however, bilious gastric residuals suddenly increased again on postoperative day (POD) 11. Sonography revealed small bowel intussusception around the nasojejunal tube. As spontaneous reduction did not occur after tube removal, surgical reduction using the Hutchinson technique was performed on POD 20, including the release of adhesions between the intussusceptum and intussuscipiens of the jejunal intussusception. The patient experienced an uneventful course after surgical reduction.
Sonography should be performed to screen for small bowel intussusception in patients presenting with bilious vomiting during nasojejunal tube placement. The prompt removal of the tube following a diagnosis of small bowel intussusception (SBI) is essential to prevent adverse events, such as adhesions between the intussuscepted bowel loops. If intussusception does not resolve shortly after tube removal, surgical intervention is indicated.
鼻空肠管置入是小肠套叠的罕见原因。通常通过拔除管子进行治疗，但少数病例需要手术复位。我们报告一例因鼻空肠管导致的小肠套叠病例，该病例发生在回肠闭锁手术后不久，尽管拔除了管子仍需要手术复位。
一名女婴在出生当天接受了III - A型回肠闭锁的肠吻合术。放置了一根鼻空肠管用于腹部减压，直到临时吻合口通道梗阻情况改善。肠扩张成功缓解；然而，术后第11天胆汁性胃残余物突然再次增加。超声检查显示鼻空肠管周围存在小肠套叠。拔除管子后套叠未自行复位，于术后第20天采用哈钦森技术进行了手术复位，包括松解空肠套叠的套入部与被套部之间的粘连。手术复位后患者恢复顺利。
对于在鼻空肠管置入期间出现胆汁性呕吐的患者，应进行超声检查以筛查小肠套叠。诊断小肠套叠后及时拔除管子对于预防不良事件（如套叠肠袢之间的粘连）至关重要。如果拔除管子后套叠未很快缓解，则需进行手术干预。
