Differential diagnosis of pediatric gastrostomy tube malfunction and pediatric gastrojejunostomy tube malfunction

• Gastrostomy tube tip initial placement is malpositioned outside of stomach
• Gastrostomy tube tip replacement is malpositioned outside of stomach
• Gastrostomy tube balloon causing gastric outlet obstruction
• Gastrostomy tube leak / fracture
• Gastrojejunostomy tube tip initial placement is malpositioned outside of bowel
• Gastrojejunostomy tube tip replacement is malpositioned outside of bowel
• Gastrojejunostomy tube retention balloon causing gastric outlet obstruction
• Gastrojejunostomy tube tip initial placement is in stomach
• Gastrojejunostomy tube tip causing jejunal-jejunal intussusception
• Gastrojejunostomy tube leak / fracture

Approach to the differential diagnosis of gastrostomy tube malfunction and gastrojejunostomy tube malfunction:

• The correct position for the tip of a gastrostomy tube after placement or replacement should be over the stomach, any other position is suspect
• The correct position for the tip of a gastrojejunostomy tube after placement or replacement should be near the duodenal-jejunal junction, any other position is suspect
• Any free air resulting from initial tube placement should resolve by several days after placement, free air in a symptomatic patient is suspect
• Suspect gastrostomy tubes should be injected with water soluble contrast looking for malposition of the tube tip outside of the stomach or gastric outlet obstruction from the balloon
• Suspect gastrojejunostomy tubes should be injected with water soluble contrast looking for malposition of the tube tip outside of the bowel or jejunal-jejunal intussusception caused by the tube tip or downstream small bowel obstruction from other etiologies