B

Figure 1.11. Incarcerated Cantor tube. (A) Supine film of the abdomen (A) showing a Cantor tube in the distal small bowel. Attempts at withdrawing the tube were unsuccessful, so the tube was cut loose and allowed to pass distally (B).

Percutaneous puncture of the balloon is a relatively safe and well-tolerated option. Use of a small-gauge needle allows safe passage through the small-bowel wall without undue risk of injury and leakage of intestinal contents even in the face of obstruction [34]. CT guidance helps to avoid the transgression of the colon or other organs, but some authors found fluoroscopy a better alternative [33] (Fig. 1.12). A more esoteric, but not readily available method of decompressing the balloon is that of placing the patient in a hyperbaric chamber [36]. This allows successful reduction in the size of the balloon and subsequent removal.

Even nonballoon catheters may be prone to similar problems. One case report involves a single-lumen mushroom catheter that had its nipple balloon to an obstructive degree [33]. In the manufacture of this device, a small amount of gauzelike material is introduced into the nipple to occupy the potential space between the leaves of latex. This potential space eventually acted like the latex balloons just discussed and becomes filled with intestinal gas. Percutaneous puncture successfully decompressed this catheter as well.

Figure 1.12. Decompression of air-filled mercury bag of a Cantor tube. Spot film of the lower abdomen during a fluoroscopic attempt at decompressing the air-filled mercury bag of a Cantor tube. This was necessitated by a small-bowel obstruction caused by the dilated mercury bag.

Other complications secondary to the presence of long intestinal tubes have also been reported. Some of these are well known to clinicians and radiologists, while others are unusual (Fig. 1.13) and may warrant inclusion in the medical literature.

Overly vigorous attempts at advancing a soft nasoenteric tube may also cause buckling and loop formation of the tube. Eventually a knot may form. This presents a major problem when the tube has to be removed. Gentle retraction may allow uneventful removal [37], or an endoscopist may have to assist [38]. Another possible remedy is to insert another tube, perhaps a stiffer one, through the loop of the knot. This is similar to the angiographic approach to knotted catheters. Retracting over the stiffer tube may allow unknotting of the problematic tube.

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