Limited Utility of Plain Abdominal Radiographs in Evaluating Intussusceptions Secondary to Long Indwelling Feeding Tubes
A 74-year-old male with history of pancreatitis initially presented with jaundice, abdominal pain, distention, and diarrhea. Abdominal ultrasound and CT indicated a prominent pancreatic head, but no definite mass was demonstrated. An endoscopic ultrasound and endoscopic retrograde cholangiopancreatography showed evidence of a pancreatic head mass measuring about 3.3 cm with dilated pancreatic and common bile ducts. Fine needle aspiration showed adenocarcinoma. Endoscopic staging of pancreatic adenocarcinoma was T3N0Mx. The patient subsequently received neoadjuvant chemotherapy and a Whipple procedure. A feeding gastrojejunostomy tube was placed post-operatively. Initially the patient was recovering well, until he developed emesis, profound electrolyte abnormalities, and increased tube outputs. 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 []. 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 []. This prompted immediate exploratory laparotomy. The surgeon did not find evidence for necrotic bowel upon exploration and the tube was then removed. An intra-operative image shows the unreduced intussusception with tube still in place [].