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Gastrojejunostomy

The indications for placement of a gastrojejunostomy tube in children include severe gastro-oesophageal reflux or gastric emptying abnormalities. A gastrojejunostomy tube is placed coaxially via a gastrostomy tube. This can be done either in the same session as the gastrostomy placement or at a later moment in time. The procedure itself is relatively simple. A catheter is placed into the

Fig. 7.3. a Pull gastrostomy procedure: a guidewire is grasped by the snare within the stomach (courtesy of Dr. D.J. Roebuck, Department of radiology, Great Ormond Street Children's Hospital, London, UK). b The guidewire and snare are retrieved through the mouth. The gastros-tomy tube can be advanced over the guidewire through the esophagus. c Freka gastrostomy tube (Fresenius, Uppsala, Sweden)

stomach and directed towards the pylorus. Using a guidewire the catheter is advanced beyond the ligament of Treitz after which the catheter is exchanged for a gastrojejunostomy tube (Kaye et al. 2000a; Norman 2001).

The gastrojejunostomy procedure knows virtually no serious complications, besides those related to the placement of the gastrostomy tube. Minor complications consist of leakage of feeding from the puncture site and dislodgement of the gastrojejunos-tomy tube. A rare complication has been described by Connolly et al. (1998) in five patients in whom small bowel intussusception was seen around the gastrojejunostomy tube. We experienced the same rare complication in the case of a surgically placed jejunostomy tube (Fig. 7.4). Reduction of these intussusceptions can be achieved by bolus injection of air or water-soluble contrast medium through the gastrojejunostomy tube or by exchanging the jeju-nostomy tube over a guidewire.

Fig. 7.4. A 7-year-old girl with HSAN type II. A jejunostomy was placed because of feeding problems. Despite her condition she complained of cramping abdominal pain. The ultrasound image shows an ileo-ileal intussusception around the jejunostomy tube (asterisk). The abdominal pain was relieved after changing the jejunostomy catheter

Fig. 7.4. A 7-year-old girl with HSAN type II. A jejunostomy was placed because of feeding problems. Despite her condition she complained of cramping abdominal pain. The ultrasound image shows an ileo-ileal intussusception around the jejunostomy tube (asterisk). The abdominal pain was relieved after changing the jejunostomy catheter

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