C1321068

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Thank you for providing the X-ray.

This image shows a pediatric abdominal radiograph with a visible percutaneous endoscopic jejunostomy (PEJ) or gastrojejunostomy (GJ) tube. Here are the key observations:

Findings:

1. Tube Position: The distal end of the feeding tube is located within the stomach or proximal duodenum, appearing to form a loop that suggests it may not be in the jejunum. This raises concern for migration or retraction of the jejunal limb back into the stomach.

2. Tube Tip: The radiopaque tip of the tube is not clearly beyond the ligament of Treitz, which is typically expected for proper jejunal positioning.

3. Coiling: There appears to be some coiling or looping of the tube in the gastric or proximal duodenal region, which may contribute to feeding intolerance or vomiting.

4. No signs of perforation: There is no obvious pneumoperitoneum or free air.

5. Gastrointestinal gas pattern: There is some bowel gas, but not markedly dilated loops.

Impression:

• The feeding tube does not appear to be in the correct jejunal position and likely has migrated into the stomach or proximal duodenum.

• This malposition may be contributing to persistent vomiting, especially if feeds intended for the jejunum are being delivered into the stomach.

Recommendation:

• Confirm tube position with contrast study if clinically indicated.

• Withhold feeds via the jejunal port until correct placement is confirmed.

• Consult pediatric surgery or interventional radiology for potential repositioning if jejunal feeding is still required.

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    YI PWG - PEJ SITE MIGRATED , PERSISTENT VOMITING 

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