Gastrostomy Tube Malfunction / Malposition / Misposition / Misplacement

  • Etiology: placed in patients who require nutritional assistance
  • AXR:
    — correct position for the tip of a gastrostomy tube after placement or replacement should be over the stomach, 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
  • Complications: malposition of the tube tip outside of the stomach, tube goes through bowel loop before entering the stomach, gastric outlet obstruction from the balloon
  • Treatment: replacement of gastrostomy tube that is outside of stomach, decreasing size of gastrostomy balloon causing gastric outlet obstruction
  • Clinical: presentations include what is being infused though the gastrostomy tube is being aspirated out of a nasogastric tube in the stomach, inability to infuse through gastrostomy tube, abdominal distension, vomiting

Cases of Gastrostomy Tube Malfunction / Malposition / Misposition / Misplacement

AXR of pneumoperitoneum due gastrostomy tube malposition causing gastric perforation
Supine AXR (left) shows a gastrostomy tube projecting appropriately over the stomach with a triangular lucency superior to the stomach. Left lateral decubitus AXR (above right) again shows the triangular lucency superior to the stomach but does not show air between the abdominal wall and liver. Cross-lateral AXR (below right) shows air between the anterior abdominal wall and liver.
Enema and gastrostomy tube injection showing gastrostomy tube that was placed through colon into stomach
AP 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.
Gastrostomy tube injection of gastromy tube malposition outside of stomach
AP 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.
Gastrostomy tube injection showing gastric outlet obstruction from gastrostomy balloon
AP image from a gastrostomy tube injection shows a round filling defect in the antrum of the stomach. Only an extremely small amount of contrast was seen to empty out of the stomach after 30 minutes.