PMC5109560_01
Chest radiograph and CT scan on admission reveal diffuse consolidation in both lungs (right>left).
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A chest radiograph and CT scan showed diffused consolidation in both lungs consistent with acute pneumonia (Fig. 1).
The newly developed nasojejunal feeding tube with gastric decompression function (NJT/GD).
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On day 10, a newly developed 16Fr size nasojejunal feeding tube with gastric decompression function (NJT/GD, Fig. 2) was inserted into the jejunal lumen under fluoroscopic guidance.
Placement of NJT/GD with the use of fluoroscopy. Left: Positioning of radiopaque marker (arrow head) before the pylorus. Right: Confirmation with contrast medium.
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The NJT/GD was then inserted so that the tip was placed beyond the ligament of Treitz with the radiopaque marker positioned before the pylorus (Fig. 3, left). After the procedure, tube placement was confirmed using contrast medium again (Fig. 3, right).
Simultaneous gastric decompression (drainage) with jejunal feeding.
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Enteral feeding was recommenced on the same day of tube placement at 800 kcal/day (13 kcal/kg/day at 60 mL/hr) while simultaneously draining any residual gastric contents (Fig. 4).
Left: percutaneous endoscopic gastrostomy (PEG) performed on day 22. Middle: Endoscopic view (taken before PEG tube insertion) of NJT/GD with the radiopaque marker (arrow head) correctly placed before the pylorus. Right: Gastric decompression holes of NJT/GD (arrow heads).
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By day 22, he was well enough to undergo percutaneous endoscopic gastrostomy (PEG, Fig. 5) using the introducer method.
Clinical course and enteral nutrition provision (NGT: nasogastric tube, NJT/GD: nasojejunal tube with gastric decompression function, PEG: percutaneous endoscopic gastrostomy, TRANSFER: transfer to rehabilitation ward).
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The clinical course and enteral nutrition provision of the patient is summarized in Fig. 6.