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Case report


Limited utility of plain abdominal radiographs in evaluating intussusceptions secondary to long indwelling feeding tubes.

Albert YangChandana LallPuneet BhargavaDavid Imagawa
Radiology Department, University of California Irvine, Orange, CA, Radiology Department, University of Washington, VA Puget Sound Health Care System, Seattle WA, Department of Hepatobiliary Surgery, University of California Irvine, Orange, CA, USA
Date of Submission: 20-Oct-2012, Date of Acceptance: 01-Feb-2013, Date of Web Publication: 28-Feb-2013.
Corresponding Author:
Corresponding Author

Chandana Lall

Department of Radiology, 101 The City Drive South Orange, CA, USA.
E-mail: clall@uci.edu

Corresponding Author:
Corresponding Author

Chandana Lall

Department of Radiology, 101 The City Drive South Orange, CA, USA.
E-mail: clall@uci.edu

DOI: 10.4103/2156-7514.107994 Facebook Twitter Google Linkedin

ABSTRACT


Adult intussusception (AI) is relatively rare and can be a difficult clinical diagnosis, often requiring cross-sectional imaging for confirmation. Unfortunately, intussusceptions in the setting of indwelling long enteral feeding tubes have been predominantly characterized in the pediatric population with minimal investigation in adults. We report three cases of AI in patients with long feeding catheters serving as anatomic lead points leading to intussusception diagnosed on cross-sectional imaging. We highlight the limited utility of the supine plain films for detection of AI, and it behooves the radiologist to hold a high index of suspicion if the patient has a long enteral catheter. Since the majority of these patients tend to be fairly ill and unable to stand for upright abdominal radiographs, in the setting of percutaneous feeding tubes, decubitus abdominal radiographs should always be obtained. These cases also highlight the importance of having a high clinical suspicion of intussusceptions in a patient presenting with abdominal pain in the setting of an enteral feeding tube. In post-operative patients, other factors can predispose the patient to intussusception, including adhesions. Another interesting feature in tube related AI is the reverse intussusception that may be seen with indwelling enteral tubes. Reverse intussusception is where the distal bowel telescopes into the proximal segment over the tube.
Keywords: Adult Intussusceptions, Gastrojejunostomy Tubes, Percutaneous Jejunostomy

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