DDX of gastrostomy tube malfunction and gastrojejunostomy tube malfunction

Approach to the 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