Figure 3.55. "Lost" gastrostomy tube causing small-bowel obstruction. (A) Plain film of the abdomen showing small-bowel obstruction. The radiopaque portion of the tube is present in the

right lower quadrant, and difficult to identify. Contrast medium is present in the rectum from a previous examination. (B) Radiograph of the gas-trostomy tube showing the radiopaque portion.

necrosis from the balloon (Fig. 3.56). Other rarer complications include gastric pneumatosis, which has been reported in association with gastric outlet obstruction and/or intramural position of the tube (Fig. 3.57), gastrocutaneous fistula after tube removal, gastrocolic fistula (Fig. 3.58), intraperitoneal leakage, and hemorrhage after percutaneous placement. Gastropexy may cause the stomach to assume a character-

Figure 3.56. Gastric ulcer secondary to pressure necrosis from the gastrostomy balloon. View of the stomach after injection of contrast medium through the gastrostomy showing an ulcer along the lesser curvature aspect of the body of the stomach.

Figure 3.57. Gastric emphysema secondary to gastric outlet obstruction from gastrostomy tube. Oblique view from a water-soluble contrast study through the gastrostomy tube showing gastric outlet obstruction and gastric emphysema secondary to impaction of the tube at the pyloric channel.

Figure 3.58. Gastrostomy tube in the colon with a gastrocolic fistula. Film from gastrostomy tube injection shows the tube positioned in the colon with a fistula from the colon to the stomach.

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