Pediatric small bowel follow through done through gastrostomy tube (ersatz enterocolysis)

  • Patient preparation: none
  • Contrast used: barium or high osmolar water soluble, dilute contrast using 2 parts contrast : 1 part sodium chloride if < 1 year old or 1 part tap water if > 1 year old, determine volume to be given by asking parent the volume of an average feed in ccs over how many hours
  • Technique:
    — Scout image
    — Place the patient in a right lateral position
    — Slowly inject the contrast through the G-tube making sure to fill the patient’s stomach to its physiologic capacity by giving the patient’s feed volume slowly over 10-15 minutes in the right lateral position to facilitate gastric emptying
    — Follow contrast head through small bowel looking for level of obstruction
    — Once contrast visibly stops moving forward revert to overhead images every 30 minutes until contrast reaches colon
  • Images to obtain: lateral image of the tube tract and the tube in the stomach, AP image of the tube in the stomach, AP images of abdomen, spot images with compression as needed
  • Looking for: tube balloon causing gastric outlet obstruction, gastroesophageal reflux, slow bowel motility, small bowel narrowing or strictures, obstruction
  • Post procedure tasks: flush gastrostomy tube with sterile saline, if barium used advise patient to drink plenty of liquids to wash barium out of system and that barium will lighten color of stools