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Reminder of important clinical lesson
CASE REPORT
Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinson’s disease
  1. Paolo Cerrone1,2,
  2. Michele Marchese3,
  3. Maria Antonietta Pistoia1,3,
  4. Carmine Marini2,4
  1. 1Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  2. 2ASL 1 Avezzano Sulmona l’Aquila, Neurology Unit, San Salvatore Hospital, L’Aquila, Italy
  3. 3ASL 1 Avezzano, Sulmona L’Aquila, Surgical and Diagnostic Endoscopy Unit, San Salvatore Hospital, L’Aquila, Italy
  4. 4Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
  1. Correspondence to Dr Paolo Cerrone, paolo.cerrone{at}yahoo.it

Summary

Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson’s disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.

  • parkinson’s disease
  • drugs: gastrointestinal system
  • endoscopy

https://doi.org/10.1136/bcr-2017-223884

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    Footnotes

    • Contributors PC drafted the article. PC and MM acquired and interpreted data of the patient. CM was responsible for the conception and design of the manuscript. CM and MAP revised the manuscript critically.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.