Innovative management of intestinal obstruction with colonic transendoscopic enteral tubing
A 50-year-old man with a 15-year history of Crohn’s disease (CD) was urgently admitted due to abdominal distension, which had worsened over a week. In the preceding 3 months, he had undergone exclusive enteral nutrition. The abdominal distension persisted despite accepting symptomatic treatments such as fasting and gastrointestinal decompression. Computed tomography revealed a stenosis, 60 mm in length, at the terminal ileum, which was unsuitable for endoscopic dissection or balloon dilation. A colonoscopy was conducted following a cleansing enema to further evaluate the bowel condition, and colonic transendoscopic enteral tubing (TET) was performed to resolve the obstruction.
Colonic TET is a versatile technology used for managing various conditions in the entire colon, including fecal microbiota transplantation, drug administration, and decompression for endoscopy-associated perforation. In this case, colonic TET was innovatively employed for decompression following intestinal obstruction. The TET tube successfully passed through the pinhole stricture that was causing the obstruction. Decompression was initiated immediately upon the passage of the colonic TET through the stenosis and was well tolerated by the patient. This intervention rapidly alleviated the patient’s abdominal distension, resulting in a flattened abdomen. A total of 8135 mL of intestinal fluid was drained through the TET tube over 11 days, which created favorable conditions for the subsequent therapy. The patient then underwent successful right colon and terminal ileal resection after sufficient preoperative treatment. Post-surgery, the TET tube remained in the intestine for one week for continued drainage and decompression, thus averting post-surgery infection and promoting wound healing.
Reference:
Yu Y, Zhang F, Cui B. Innovative management of intestinal obstruction with colonic transendoscopic enteral tubing. Endoscopy. 2023 Dec;55(S 01):E1207-E1208. doi: 10.1055/a-2199-4663. Epub 2023 Nov 21.