Superior Mesenteric Artery Syndrome in a Tube-Fed Patient

Obstruction resulting from superior mesenteric artery syndrome is not often considered a possible cause for gastrostomy-tube complications in tube-fed patients. This case report details our experience with a patient who had had a feeding gastrostomy tube in place for 2 years. She then developed continuous leakage around the area of the gastrostomy insertion site associated with pain and inability to tolerate feedings. Her gastrointestinal series revealed compression of the third portion of the duodenum with delayed emptying of the stomach and dilatation of the proximal duodenum. After resection of the necrotic gastrostomy site, takedown of the ligament of Treitz to free the fourth portion of the duodenum, and insertion of a feeding jejunostomy, the patient was again able to gain weight and tolerate her tube feedings. We present this as an unusual complication occurring in a tube-fed patient.