Presentation
Day 2 post RIG insertion (tonsilar SCC on CTX). Pain overnight at the RIG tube site then acute onset of severe abdominal pain with leaking around the tube site. Insertion was uneventful and on table CT showed the RIG to be well positioned. ? RIG position.
Patient Data
Moderate volume pneumoperitoneum.
Gastrostomy tube is coursing through the left anterior abdominal wall . The balloon does not appear to be inflated and the tube has retracted since insertion imaging with the tip just adjacent to the wall of the greater curvature of the stomach. The pneumoperitoneum is likely secondary to a gastrostomy or tract from the stomach.
Previous cholecystectomy. Gastric band in situ with unchanged positioning from prior CT. The spleen, pancreas, and adrenals are normal. Low density 12 mm cyst at the upper pole of the left kidney. The kidneys are otherwise normal without hydronephrosis. Urinary bladder is distended but appears normal.
Hyperdense material within the ascending and proximal transverse colon. The large and small bowel otherwise appear normal.
The portal vein and its tributaries are patent.
Dependent atelectasis within the visualized lower lobes. No suspicious osseous abnormality.
Impression
Gastrostomy balloon is not inflated, and the tube has retracted since insertion with the tip external to the stomach adjacent to the gastric wall. Moderate pneumoperitoneum.
Case Discussion
The patient was taken around to the IR suite where the track could not be adequately recovered and the RIG removed. The patient went onto the have successful surgical PEG insertion the following day.
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