A 4-year-old premature girl with multifactorial encephalopathy, spastic tetraparesis and severe psychomotor retardation.
Multiple respiratory disease was associated with frequent aspirations.
An anti-reflux technique was performed, but an iatrogenic gastric perforation caused by undoing the antireflux, which worsened aspirations.
A gastrostomy tube with jejunal catheter was placed.
However, due to a poor social situation and the family management of the device, multiple exits of the gastrostomy tube were produced, as it was impossible to produce a nasotracheal tube 15 in 6 months.
This situation raised the possibility of performing a DPEJ.
Endoscopy was performed in the operating room under general anesthesia.
Prophylactic antibiotics and abdominal wall disinfection with povidone and tape were applied.
By means of a previous gastrostomy, the patient was diagnosed with infantile 5.9 mm obscure gastrostomy (Olympus GIF-XP160) until reaching a change of not correcting 40 cm from the stoma.
When a good discreet asymmetries and position were obtained, a correct digital pressure effect was punctured with Abbocath using a column of distilled water to prevent puncture of interposed intestinal loops, leaving a guiding power in the position.
Subsequently, three punctures were performed using a T-shaped approach (MIC-KEY J/TJ INTRODUCER KIT-1 at a distance of the same Clark).
The pexias allow the jejunal wall to be anchored to the abdominal wall, which facilitates dilation by means of a pull system, placement of a replacement catheter with a balloon of 14 F. If the gastrostomy system was used, then the patient was maintained.
The onset of tolerance was uneventful 24 hours after the secondary paralytic ileus disappeared.
During the 10-month follow-up, the JEPD is functioning, presenting only in the fifth month a loss of peristomal fluid due to local infection that was treated with antibiotics and placement of a collection bag.
He is currently tolerating nutrition without having presented more aspiration pneumonias.
