Imaging of pediatric gastrostomy tube malposition: Pearls and pitfalls

Abstract

This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube (G-tube) placement and long-term use. G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake. The article depicts the role of imaging such as contrast radiography, fluoroscopy, ultrasound, and computed tomography scans for confirming G-tube position and evaluating complications, in addition to basic anatomical considerations and placement techniques. Complications discussed include malposition, intraperitoneal placement, buried bumper syndrome, and tube malfunction. Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately. The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.

Keywords: Gastrostomy tube; Malposition; Pneumoperitoneum; Buried bumper syndrome; Bowel perforation; Bowel obstruction; Abscess

Core Tip: Gastrostomy tube (G-tube) complications can be evaluated using fluoroscopy or 2-view contrast radiography with positive contrast injection. Presence of intraluminal contrast with gastric contour and rugae, normal emptying into the duodenum and confirmation of balloon positioning are key indicators of appropriate positioning. Awareness of critical complications associated with G-tube helps in early recognition and better patient management. These conditions include intraperitoneal placement, bowel perforation, colonic or esophageal placement, buried bumper syndrome and local abscess.