From the Guidelines
The G-tube is properly positioned in the stomach with no evidence of complications, and the presence of a duodenal diverticulum is an incidental finding that does not require treatment unless symptomatic. The contrast study shows normal flow of contrast through the stomach, duodenum, and proximal jejunum without any leakage outside the gastrointestinal tract, as expected in a correctly placed G-tube 1. The duodenal diverticulum is a common anatomical variant found in approximately 20% of the population, and it typically does not require treatment unless it becomes symptomatic.
The potential complications of G-tube placement, as outlined in the guidelines from the Society of Interventional Radiology and American Gastroenterological Association, include major complications such as aspiration, hemorrhage, peritonitis, and death, with frequencies ranging from 0.3-2.1% 1. However, in this case, there is no evidence of contrast extravasation, which suggests that the G-tube is functioning properly and there are no immediate complications.
Some key points to consider in the management of the G-tube include:
- Regular tube care, including site cleaning and checking for proper positioning before each use
- Monitoring for signs of complications, such as bleeding, infection, or leakage
- Avoiding anticoagulation during the procedure, as it increases the risk of bleeding 1
- Being aware of the potential for minor complications, such as peristomal infection, stomal leakage, or buried bumper, which can occur in up to 30% of cases 1.
Overall, the findings of the GI series suggest that the G-tube is properly positioned and functioning correctly, and no immediate intervention is needed based on these findings.
From the Research
Gastrointestinal Series Findings
The findings of the gastrointestinal (GI) series indicate that the Gastrostomy tube (G-tube) is correctly placed within the stomach, with contrast opacifying the stomach, duodenum, and proximal jejunum. A duodenal diverticulum is present, but there is no evidence of contrast extravasation.
Duodenal Diverticulum
- A duodenal diverticulum is a common incidental finding, usually asymptomatic, but can cause complications such as bleeding or perforation 2, 3, 4, 5, 6.
- The presence of a duodenal diverticulum can be diagnosed using imaging studies such as CT scans or upper GI fluoroscopy 4.
- Endoscopy can be an effective alternative to surgery in the management of a bleeding duodenal diverticulum 2, 5.
Clinical Implications
- The absence of contrast extravasation suggests that there is no perforation of the duodenal diverticulum 4, 6.
- The presence of a duodenal diverticulum should be considered in the differential diagnosis of upper-GI bleeding of unknown origin 2, 5.
- Surgical management may be necessary in cases of complicated duodenal diverticulum, such as perforation or bleeding 3, 6.