Severe small intestinal bacterial overgrowth syndrome after jejunal feeding requiring surgical intervention: a case report and review of the literature

Background Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO...

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Bibliographic Details
Published in:BMC gastroenterology 2022-06, Vol.22 (1), p.1-300, Article 300
Main Authors: Aboona, Majd B, Wong, Tina W, Del Prado, Paul R, Paley, Keith, Goldberg, Ross F, Weimer, Samuel, Dave, Harikrishna, Hobohm, Dan, Smith, Adam
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Adenocarcinoma
Antibiotics
Bacteria
Care and treatment
Case Report
Chemotherapy
Diseases
Electrolytes
Enteral feeding
Enteral nutrition
Gastric cancer
Gastric outlet obstruction
Gastroenterology
Intestine, Small
Laparotomy
Literature reviews
Methods
Morbidity
Motility
Nausea
Necrosis
Nutrition
Ostomy
Parenteral nutrition
Patients
Peritonitis
Physiological aspects
Pneumatosis intestinalis
Portal venous gas
Small intestinal overgrowth syndrome
Small intestine
Surgery
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Summary:Background Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention. Case presentation A 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition. Imaging revealed diffuse pneumatosis and portal venous gas. Surgical exploration confirmed segmental bowel necrosis requiring resection. Histologic findings were consistent with SIBO. Conclusions Presentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality. Keywords: Small intestinal overgrowth syndrome, Pneumatosis intestinalis, Portal venous gas, Enteral feeding, Gastric cancer, Gastric outlet obstruction, Immunosuppression
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-022-02370-2