PMC8213475_01
Abdominal X-ray demonstrating severe gaseous distention of the entire stomach with the balloon of presumed gastrostomy projecting over the right abdomen. The tip of a jejunostomy tube placed through the gastrostomy projects over the left midabdomen (yellow arrow). There is no gross evidence of free air noted given inherent limitations of this portable supine radiograph.
CRIGM2021-4325443.001.jpg
PMC8213475_01_CRIGM2021-4325443.001.jpg
fig1
An abdominal plan radiograph revealed severe gaseous distension of the stomach and a large volume of stool in the colon (Figure 1).
Axial and coronal computed tomography of the (a) abdomen and (b) and pelvis (with contrast) demonstrating enteroenteric intussusception at the junction of the second and third portions of the duodenum (red asterick) with the jejunostomy limb acting as the presumed lead point.
CRIGM2021-4325443.002.jpg
PMC8213475_01_CRIGM2021-4325443.002.jpg
fig2
A paucity of enteral fluid with a concentric soft tissue density surrounding the enteric catheter was shown at the junction of the second and third portions of the duodenum (Figure 2).
Esophagogastroduodenoscopy demonstrated retained semisolid food at the pyloric junction (a), significant bowel obstruction due to intussusception likely as a result of mucosal traction from the patient's jejunostomy limb tip at the second portion of the duodenum (b), and subsequent patent bowel following reduction in the intussuscepted bowel following reduction (c). The jejunostomy was also removed being replaced with a gastrostomy tube.
CRIGM2021-4325443.003.jpg
PMC8213475_01_CRIGM2021-4325443.003.jpg
fig3
The endoscopy confirmed that the jejunostomy tube held traction on a segment of the distal bowel that had invaginated into the second portion of the duodenum (Figure 3).