CASE 13868 Published on 21.07.2016

Filling of well-placed percutaneous endoscopic gastrostomy tube

Section

Interventional radiology

Case Type

Anatomy and Functional Imaging

Authors

Barbara Bonnesen

Hellerup, Denmark;
Email:d010796@dadlnet.dk

Patient

37 years, male

Categories

Area of Interest Abdomen, Stomach (incl. Oesophagus) ; Imaging Technique Conventional radiography

Procedure Contrast agent-oral, Contrast agent-other ; Special Focus Eating disorders ;

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Clinical History

Multitrauma from traffic accident with multiple fracture to the face, base of the skull, columna, costae and left femur as well as substantial soft tissue injury.
Had not been able to eat and has had a percutaneous endoscopic gastrostomy tube placed. Conventional radiology was performed to visualize placement.

Imaging Findings

Filling of anatomically normal stomach with Visipaque contrast though percutaneous endoscopic gastrostomy tube. The contrast is injected into the stomach through the tube during X-ray exposing and recording.
Clips point at the percutaneous endoscopic gastrostomy tube entry point on the skin.

Discussion

Percutaneous endoscopic gastrostomy tube feeding is associated with a lower probability of intervention failure than nasogastric tube feeding, and hence is preferred for patients in need of long-term feeding tube assistance [1]. The most common serious complication of a nasogastric tube is not identifying a misplaced tube within the lungs [2]. A percutaneous endoscopic gastrostomy tube is considered a more secure method of feeding patients who require longer-term nutritional support [3], however, there are reports of patients dying from sepsis after a percutaneous endoscopic gastrostomy tube dislodgement to the peritoneum in relation to tube repositioning without radiological confirmation of the new position [4].

Differential Diagnosis List

Normal stomach anatomy with correctly placed percutaneous endoscopic gastrostomy tube.

Abnormal stomach anatomy

Incorrectly placed percutaneous endoscopic gastrostomy tube with access to peritoneum

Final Diagnosis

Normal stomach anatomy with correctly placed percutaneous endoscopic gastrostomy tube.

References

[1] Gomes CA Jr, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR and Waisberg J (2015) Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 22;(5):CD008096 (PMID: 25997528)

[2] Scott R and Bowling TE. (2015) Enteral tube feeding in adults. J R Coll Physicians Edinb 45(1):49-54 (PMID: 25874832)

[3] Rowat A (2015) Enteral tube feeding for dysphagic stroke patients. Br J Nurs 12-25;24(3):138 (PMID: 25679242)

[4] OʼRear JM and Prahlow JA. (2015) Early percutaneous endoscopic gastrostomy tube dislodgment. Am J Nurs 115(6):26-31 (PMID: 25970629)

Case information