Case report: Rupture of an ileus tube in a patient with recurrent rectal cancer

Abstract

The insertion of an ileus tube is an important treatment for intestinal obstruction. According to previous reports, jejunal intussusception has been reported as a complication associated with ileus tube placement. However, rupture of the weighted tip of an ileus tube has not been reported before. Herein, we report a 55-year-old Chinese woman who underwent radical proctectomy (DIXON) for rectal cancer and developed pelvic recurrence and lung metastasis 65 months after surgery, accompanied by symptoms of acute intestinal obstruction. An ileus tube was inserted before the operation (extensive total hysterectomy, bilateral adnexal resection, rectal Hartman operation, partial enterectomy, and intestinal adhesion lysis). Rupture of the ileus tube occurred after the operation and was treated with paraffin oil and enteral nutrition, and the metal beads and spring were eliminated through the colostomy. During the follow-up, the patient received targeted therapy plus immunotherapy, which was successful: the quality of life of the patient was excellent, and no obvious abnormal symptoms were found. Endoscopy-assisted ileus tube insertion should be performed under intravenous anesthesia, and a knot should be tied at the tip of the ileus tube before insertion so that the ileus tube can be inserted easily by grasping the thread with biopsy forceps(the "thread-knotting" method). With the above methods, the procedure of ileus tube insertion could be improved to reduce the incidence of tube-related rupture.

Keywords: complication; ileus tube; intestinal obstruction; rectal cancer; recurrence or metastasis.

Figure 1

Imaging before the insertion of an ileus tube (A) CT showed that the pelvic lesions (white arrow) had progressed significantly. (B) CT showed that multiple metastatic nodules (white arrow) were located in both lungs. (C) CT showed that the obstruction was located in the terminal ileum that had been invaded by the large pelvic tumor (white arrow). (D) The small bowel became significantly dilated due to the obstruction (white asterisk).

Figure 2

Imaging after the insertion of an ileus tube (A) CT showed that the intestinal obstruction was improved, and the head of the tube was now in the left lower abdomen. (B) CT showed no metallic shadow, and the rest of the CT findings were normal. (C) CT did not show intestinal obstruction or intestinal leakage but showed separation between the metal beads at the head of the ileus tube. (D, E) Follow-up CT showed that six scattered metal beads had moved toward the distal small intestine with no signs of intestinal obstruction or perforation.

Figure 3

(A) Intraoperative exploration showed that an 18*15 cm cystic mass(black asterisk) was seen in the right ovary. (B) The metal beads(black arrow) and spring(white arrow) were eliminated through the colostomy. (C) The wall of the weighted tip(white arrow) was damaged caused by the biopsy forceps. (D) A knot was tied at the tip of the ileus tube before insertion (“thread-knotting” method). (E) The ileus tube could be inserted easily by grasping the thread (black arrow) with biopsy forceps (white arrow).