Gastrojejunostomy Tube Malfunction

  • Etiology: placed in patients who require nutritional assistance
  • AXR:
    — a gastrojejunostomy tube tip that crosses to the right of the spine and then heads superiorly before turning back to the left of the spine is most likely still in the stomach
    — a gastrojejunostomy tube tip that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine is most likely in the duodenum or jejunum
    — 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
  • Fluoroscopy: extravasation of contrast into peritoneum, contrast filling small bowel or colon before or at same time stomach is filled, gastric outlet obstruction, jejunal obstruction at the level of the jejunostomy tube tip
  • Complications: malposition of the tube tip outside of the bowel, tube goes through bowel loop before entering the stomach, jejunal-jejunal intussusception caused by the tube tip, downstream small bowel obstruction from other etiologies
  • Treatment: replacement of gastrojejunostomy tube that is outside of bowel or causing a jejunal-jejunal intussusception
  • Clinical: presentations include what is being infused though the gastrojejunostomy tube is being aspirated out of a nasogastric tube in the stomach, inability to infuse through gastrojejunostomy tube, abdominal distension, vomitting

Cases of Gastrojejunostomy Tube Malfunction

AXR showing gastrojejunostomy tube in appropriate position
AXR shows the tip of the gastrostomy tube projecting over the stomach and the tip of the gastrojejunostomy tube projecting near the duodenal-jejunal junction.
Gastrojejunostomy tube injection showing appropriate position of the tube tip
AP image from a jejunostomy tube injection shows the tip of the jejunostomy tube in the jejunum. Subsequent image showed no evidence of downstream small bowel obstruction.
AXR of pneumoperitoneum due to malposition of gastrojejunostomy tube outside of bowel
Supine AXR (above) shows the tip of the gastrojejunostomy tube extending deep into the pelvis. Left lateral decubitus AXR (below) shows air between the abdominal wall and the liver.
AXR and gastrojejunostomy tube injection of pneumoperitoneum due to malposition of the gastrojejunostomy tube outside of the bowel
Supine (above left) and left lateral decubitus (above right) AXR show no evidence of air between the abdominal wall and the liver but on the decubitus view several concerning air bubbles project over the liver and appear extra-lumenal. The gastrojejunostomy tube was exchanged for a gastrostomy tube and AP image from a gastrostomy tube injection with water soluble contrast (below) shows contrast extravasating inferiorly out of the duodenum at the junction of the second and third parts of the duodenum.