PMC3625884_01
Albert Yang
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F1
Sequential kidney, ureters, and bladder radiographs in the intensive care unit showed only mild proximal small bowel dilatation, and reported a probable ileus pattern likely due to pain medication [Figure 1].
Case 1: Sequential abdominal radiographs show mild proximal small bowel dilatation reported as post-operative ileus: (a) On admission, (b) 24 hours later and (c) 48 hours later. Black arrow indicates the distal tip of the percutaneous jejunostomy feeding tube in all sequential radiographs.
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F2
With escalation of symptoms, CT scan was performed, which showed long segment entero-enteric intussusception with the gastrojejunal feeding tube acting as a lead point [Figure 2].
Case 1: (a - d) Coronal CT slices with contrast via feeding tube, progressing from posterior to anterior of the patient, demonstrating the intussusception with the GJ tube as an anatomic lead point (Figure 2a, dashed white line). The white solid line (Figure 2a) depicts the distal portion of the intussusception and arrowhead in d points to the tube. (e and f) Sagittal images that show intussusception in the distal small bowel. (g and h) Axial CT images of the abdomen that show a loop of distal small bowel (star) engulfed within another segment (Figure g, white arrow).
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F3
An intra-operative image shows the unreduced intussusception with tube still in place [Figure 3].
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Case 1: Gross specimen shows a reverse long segment intussusception with distal bowel telescoping into a proximal segment (white arrow).
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F4
Abdominal radiographs showed no features of obstruction [Figure 4].
Case 2: (a) Supine and (b) semi-upright abdominal radiographs demonstrate scattered, mildly dilated small bowel loops without significant air fluid levels. Radiographs read as mild ileus pattern. Due to progression of abdominal pain, CT of the abdomen and pelvis was ordered, which illustrated a long loop intussusception over the percutaneous jejunostomy feeding tube. The feeding tube was a Kendel 12 French feeding jejunostomy tube.
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F5
Since symptoms were progressive, CT imaging was ordered and showed the distal tip of the percutaneous jejunostomy tube acting as an anatomic lead point for longer length intussusceptions [Figure 5a and b].
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Case 2: (a and b) Axial CT images, with IV contrast introduced peripherally and without bowel contrast. CT images of the patient demonstrate distal tip of the percutaneous jejunostomy tube (white arrow) within the distal small bowel. Figure 5b illustrates a lower attenuating surrounding area around the tip (white arrow). Encircling that focal area is a larger bowel segment (intussuscipiens) with higher attenuation (dashed white arrow).
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F6
Patient presented with abdominal pain and had a portable supine abdominal radiograph [Figure 6a], which showed presence of a percutaneous feeding jejunostomy catheter without significant bowel dilatation. Due to persistent patient discomfort, a CT scan of the abdomen and pelvis was performed with introduction of bowel contrast via jejunostomy tube [Figure 6b-e]. This showed a long segment intussusception over with the jejunostomy tube acting as the lead point [Figure 6c, black arrow indicating tip of J tube].