PROCEDURE:  CT-guided gastrostomy tube placement

DATE: 

CLINICAL INDICATION: __-year-old male achalasia, small bowel obstruction, unable to place nasogastric tube. Venting gastrostomy tube  

OPERATING PHYSICIANS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)    

MEDICATIONS: Versed 1 mg, 25 mg fentanyl and Ancef 1 g 

COMPLICATIONS:  None

 

PROCEDURE: 

The risks, benefits and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained. 

The patient was placed supine on the CT scan table. A skin marker was placed. A time out/call to order was performed. 

Preliminary CT images were obtained to delineate the location of the stomach and a mark was placed on patient’s skin. The skin was prepped and draped in the usual sterile fashion. The subcutaneous tissues about the puncture site were infiltrated with lidocaine. The lidocaine needle was left in place and several CT slices obtained to confirm position. 

An 18-gauge Chiba needle was advanced into the stomach until air was aspirated and a Amplatz wire was advanced through the needle. CT images confirmed intragastric position. 3 T-fasteners were placed to appose the gastric wall to the anterior abdominal wall. CT images were again used to confirm apposition of the anterior gastric wall to the anterior abdominal wall.  The 18-gauge needle was removed over the wire and the tract serially dilated. Finally a 14 French APDL was placed over the wire. The the wire was removed. The Cope loop was formed and locked. Imaging was performed to confirm location. The gastrostomy tube was sutured in place and sterilely dressed.

The drain was connected to a drainage bag.  The patient tolerated the procedure well and left the department in stable condition. 

 

FINDINGS: 

  1. CT scan demonstrates adequate window for gastrostomy tube placement
  2. Successful CT-guided placement of gastrostomy tube.

 

IMPRESSION:  

Uneventful CT-guided gastrostomy tube placement for venting as described above.