Case Summary
An 80‐year‐old man with a 19‐year history of Parkinson's disease (PD) was proposed levodopa‐carbidopa intestional gel (LCIG) therapy due to disabling motor fluctuations and despite optimized oral levodopa (LD) treatment. In 2015, the patient underwent percutaneous endoscopic gastrojejunostomy (J‐PEG) for LCIG infusion with great benefit to motor symptom function. Two years later, the patient reported the recurrence of fluctuations and dyskinesia, despite increased daily LCIG dosage. Apparently, the pump worked normally without signs of flush hindrance (ie, blockage or high pressure alarm). Two days later, complete anal exteriorization of the jejunal tube (J‐tube) spontaneously occurred, with the classical “pigtail” appearance (Fig. 1), and without further adverse events. In the next days, after J‐tube replacement, the patient safely returned to LCIG.
Figure 1.
Complete anal extrusion of the jejunal tube with the classical “pigtail” appearance.
In the last decade LCIG administration through J‐PEG emerged as an effective tool for managing the motor fluctuations of the advanced PD stages.1 The J‐tube has a pigtail ending to prevent retrograde dislocation (Data S1), but technical problems, including tube migration or erosion, occlusion by crystallized gel, kinking, or knotting may occur in 57–69% of the patients.2
Unlike previous fatal reports after J‐tube dislocation (mechanical ileus, fistulisation, and intestinal wall perforation),3, 4 in this case the J‐tube accidentally detached, advanced within the intestine, was propelled by peristalsis, and was spontaneously expelled through the anus without any adverse events.
When this rare complication occurs, conservative treatment with close follow‐up should be performed, provided there are no signs of acute abdomen.
Author Roles
(1) Research Project: A. Conception, B. Organization, C. Execution; D. Supervision; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique.
G.C.: 1A, 1B, 1C, 1D, 3B
M.S.: 1C, 3A, 3B
Mar.M.: 1C, 3A, 3B
D.M.: 1C, 3A
L.S.: 1C, 3A
Mau.M: 1C, 3A
P.P.: 1C, 3B
Disclosures
Ethical Compliance Statement: The authors confirm that the approval of an institutional review board was not required for this work. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
Funding Sources and Conflict of Interest: No funding was received for this article. These authors declare no conflicts of interest.
Supporting information
Data S1. Supplemental Methods 1. PEG Procedure.
Relevant disclosures and conflicts of interest are listed at the end of this article.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data S1. Supplemental Methods 1. PEG Procedure.