# Duodenal Stenosis With Significant Edema Due to Complication From an Enteral Nutrition Tube: A Case Report

## TL;DR

A patient developed duodenal stenosis and edema after an enteral nutrition tube was placed in the duodenal bulb, leading to vomiting and requiring repositioning of the tube.

## Contribution

Highlights a rare complication of enteral nutrition tube placement in the duodenal bulb and suggests avoiding this location to prevent obstruction.

## Key findings

- Enteral nutrition tube placement in the duodenal bulb caused significant edema and stenosis.
- Repositioning the tube to the stomach and fasting improved gastric residual volume.
- The anatomical location of the duodenal bulb increases the risk of obstruction from tube placement.

## Abstract

Enteral nutrition (EN) is a well-established feeding method for individuals with dysphagia or those with intubation. Although EN tube placement is generally well tolerated, complications can sometimes occur. A 60-year-old male was brought to our hospital after being struck by a container that had slid off the trailer bed. He sustained severe traumatic brain injury, pelvic fracture, and open fracture of the lower leg, for which appropriate treatment was initiated. No abnormalities were identified in other organs on CT. As mechanical ventilation management was continued, EN was administered via an EN tube placed in the duodenal bulb. On day 26, he experienced excessive vomiting and an increase in gastric residual volume (GRV). Despite medication adjustments and reduced feeding volume, only minimal improvement was observed. On day 33, upper gastrointestinal endoscopy revealed significant edematous changes in the duodenal bulb, near the tip of the EN tube, indicating a possible stenosis. The EN tube was repositioned into the stomach, and he was managed with fasting and fluid replacement, leading to a gradual reduction in GRV. As illustrated in this report, the placement of an EN tube in the duodenal bulb - an area located at an acute angle to the descending portion of the duodenum and part of the retroperitoneal space - should be avoided to prevent potential obstruction.