B

Figure 1.14.

Intussusception about a Cantor tube. Overhead film from a small-bowel series (A) shows a filling defect in the jejunum. A spot film from the same exam (B) reveals the coiled-spring appearance of an intussusception about the Cantor tube.

When multichannel long intestinal tubes are used for decompression, care must be taken that medications and contrast media are placed in the proper lumen. If not, inadvertent overdistention of the balloon can occur.

Not without their own set of problems are tubes placed directly into the jejunum for feeding purposes. These may be inserted incidentally during more extensive intra-abdominal procedures or as a separate procedure. The overall complication rate is approximately 10% [41]. These problems may include infarction, intraperitoneal leaks and perforation, and even volvulus [41,42]. Tube jejunostomies were found to have more frequent complications than needle catheter jejunostomies [41]. These may include kinking or adhesions at the insertion site, leading to bowel obstruction (Fig. 1.15), pleating and foreshortening of the bowel over the tube (Fig. 1.6A,B), frank intussusception, or obstruction from the balloon tip of a tube (Fig. 1.16C).

Figure 1.15. Small-bowel obstruction secondary to a jejunostomy tube. Supine radiograph of the abdomen (A) reveals dilated loops of small bowel in the left upper quadrant. A jejunostomy catheter is present. A small-bowel series on the same patient (B) demonstrates an abrupt transition in the caliber of the small bowel (incomplete small-bowel obstruction) at the insertion site of the jejunostomy tube.

Figure 1.15. Small-bowel obstruction secondary to a jejunostomy tube. Supine radiograph of the abdomen (A) reveals dilated loops of small bowel in the left upper quadrant. A jejunostomy catheter is present. A small-bowel series on the same patient (B) demonstrates an abrupt transition in the caliber of the small bowel (incomplete small-bowel obstruction) at the insertion site of the jejunostomy tube.

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