malposition of the gastrostomy tube

Toddler after

a gastrostomy tube change. AP radiograph of the abdomen after injection of water soluble contrast through the gastrostomy tube shows contrast outlining the spleen and several loops of small bowel. There is no contrast in the stomach.The diagnosis was gastrostomy tube malfunction with the tip of the gastrostomy tube in the peritoneal cavity.

Toddler whose

gastrostomy tube was just replaced with difficulty. AP (left) and lateral (right) images after the injection of water soluble contrast through the gastrostomy tube show the injected contrast is not in the stomach but is outlining the haustra of the colon.The diagnosis was gastrostomy tube malposition with the tip of the gastrostomy tube in the retoperitoneum.

Infant who

has just undergone a gastrostomy tube replacement which was technically difficultAP image from a gastrostomy tube injection done with water soluble contrast (left) shows none of the injected contrast conforming to the lumenal contour of the stomach. AXR taken 15 minutes later (right) shows the extravasated contrast diffusing throughout the peritoneum and outlining loops of bowel and being excreted in the bladder.The diagnosis was malposition of the gastrostomy tube replacement outside of the stomach.

Infant with

vomiting after gastrostomy tube placement a week agoAP image during an enema shows a fixed lumenal caliber change or filling defect caused by the gastrostomy tube balloon in the mid transverse colon. Early lateral image during gastrostomy tube injection with water soluble contrast (above right) shows the gastrostomy balloon and tip within the stomach. Later lateral image during gastrostomy tube injection (below right) shows contrast refluxing back from the stomach along the gastrostomy tube tract into the colon which is anterior to the stomach.The diagnosis was initial malposition of the gastrostomy tube through the colon and then into the stomach.

Teenager with

left lower quadrant pain. Axial (above left) and sagittal (above right) CT with contrast of the abdomen shows the anchoring balloon and tip of the gastrostomy tube are in the subcutaneous tissues of the anterior abdominal wall rather than in the stomach. Lateral image from an injection of the gastrostomy tube (below) shows contrast flowing through the gastrostomy tube track and entering the stomach. Again, the gastrostomy tube anchoring balloon and tip of the gastrostomy tube are not in the stomach.The diagnosis was gastrostomy tube malfunction with migration of the gastrostomy tube tip out of the stomach.

Teenager

developing a large body mass index due to steroid use who is having problems with their gastrostomy tube feedings. Lateral image of the abdomen is obtained during injection of the gastrostomy tube shows that the gastrostomy tube balloon is outside of the stomach and contrast is flowing along the gastrostomy tube track into the stomach.The diagnosis was gastrostomy tube malfunction due to the gastrostomy tube being pulled back along its tract as the patient’s body mass index increased and the gastrostomy tube was too short.