Enterocutaneous fistula as a long-term complication of jejunostomy tube placement in a dog with hyperadrenocorticism.

BACKGROUND

Jejunostomy tube (JT) feeding is a practical method of delivering enteral nutrition in dogs when oral, oesophageal or gastric feeding is not feasible, particularly in postoperative or critically ill patients with gastric, duodenal, proximal jejunal, or pancreatic disease. Although generally well-tolerated, JT placement is an invasive procedure associated with potential complications, requiring close postoperative monitoring. Certain underlying conditions may further increase the risk of adverse outcomes. Hyperadrenocorticism (HAC), in particular, is associated with impaired wound healing and increased susceptibility to infections, potentially predisposing affected patients to delayed complications following enteral feeding tube placement and removal.

CASE PRESENTATION

An 11-year-old, 2.9 kg Maltese dog presented with persistent gastrointestinal signs and focal cellulitis with purulent discharge. The dog had previously undergone intestinal anastomosis and JT placement for foreign body removal, with an uneventful recovery. Four months postoperatively, ultrasonography and fistulography confirmed an enterocutaneous fistula extending from the subcutaneous tissue to the intestinal lumen. Concurrently, HAC was diagnosed based on a post-stimulation cortisol level exceeding 20 µg/dL following an adrenocorticotropic hormone (ACTH) stimulation test. Given HAC's pathophysiological effects -including glucocorticoid-induced dermal atrophy, diminished tissue elasticity, and increased infection susceptibility- HAC was suspected to have contributed to fistula formation. Surgical treatment comprised of jejunal resection and anastomosis, as well as excision and debridement of the fistular tract. The patient exhibited no recurrence over a three-year follow-up period with sustained medical management of HAC using trilostane therapy.

CONCLUSIONS

This case highlights enterocutaneous fistula as a delayed and previously unreported complication of JT placement in a dog with HAC. Given the adverse effects of HAC on wound healing, clinicians should recognize the potential for such complications and implement vigilant postprocedural monitoring and appropriate endocrine management in patients undergoing enteral tube placement.