Nasogastric tubes,
ostomies,
biliary drainage catheters and stents are the most frequent devices that we all should be acquainted with.
Other devices,
such as transjugular intrahepatic portosystemic shunt (TIPS),
metallic coils and embolization material are less usual to come across.
NASOGASTRIC,
NASODUODENAL AND NASOJEJUNAL TUBES (Fig1,
Fig2)
They are the most common devices found in radiographs,
with the distal end of the tube located in the stomach,
duodenum or proximal jejunum.
Uses:
- Patient nutrition
- Temporal decompression of stomach and small intestine.
- Obtaining samples of the stomach contents.
- Gastric purging.
They are safe and effective,
but there are some possible complications:
- Increased risk of aspiration of gastrointestinal contents.
- Malposition,
with the distal end located in the tracheobronchial tree.
- Perforation of the gastrointestinal tract.
- Hemorrhage.
- Malfunction,
usually secondary to obstruction.
GASTROSTOMY AND JEJUNOSTOMY (Fig3,
Fig4,
Fig5)
They can be placed surgically or combining endoscopic and percutaneous radiographic techniques (PEG).
They are located in the anterior abdominal wall with the distal end in the stomach or proximal jejunum,
kept it in position by an inflated balloon inside.
Stomach/jejunum must be placed in contact with the abdominal wall.
They allow long-term or even definitive enteric alimentation.
Complications:
- Misplacement or output of the tube.
- Obstruction or tear of the tube.
- Wall necrosis and perforation.
- Hemorrhage.
- Infection.
COLOSTOMY (Fig6,
Fig7,
Fig8)
The colon is externalised to the skin surface.
- Lateral colostomy,
transitory,
the mobile segments of the colon (sigmoid and transverse) are externalised without stopping the continuity.
- Terminal colostomy,
most common,
the colon is sectioned usually after the resection of part of it.
Complications: parastomal hernia,
occlusion or retraction of the stoma,
hemorrhage,
suppuration and necrosis.
Ileostomy: when the terminal ileum and not the colon is externalised.
GASTRIC BAND (Fig9)
It is an alternative to bariatric surgery for losing weight in morbidly obese patients without permanently altering the gastrointestinal system.
An adjustable band is placed laparoscopically around the gastric fundus,
near to the gastro-esophageal junction.
It is connected to a subcutaneous port which permits calibration of the band,
allowing more or less food in the stomach.
Complications: disconnection of the subcutaneous implant,
displacement of the band,
stenosis,
infection or gastric perforation.
BILIARY DRAINAGE CATHETERS AND STENTS (Fig10 Fig11,
Fig12,
Fig13,
Fig14)
They are placed endoscopically,
percutaneously or surgically to allow the proper passage of bile from the intrahepatic tract to the duodenum.
The stents can be plastic,
or usually metallic.
Indications:
- Obstructive jaundice,
generally palliative in unresectable tumors
- Sometimes in benign strictures.
- Before or after biliary surgery
There are three types of drainages:
- Internal: anterograde drainage to duodenum
- External: retrograde drainage to an external bag.
- Internal–External: using a Kher tube,
common after cholecystectomy.
It´s T shaped with the long end to the skin and the short ends to the duodenum and the common bile duct.
Complications: misplacement,
obstruction,
infection,
leaks or hemorrhage.
SURGICAL DRAINS (Fig15,
Fig16)
They are used to eliminate fluid collections (blood or liquid) before they form abscesses and thus facilitate the healing of the surgical wound.
They are also used to drain abscesses once formed.
The type of drainage used in each case generally depends on the surgeon and his experience.
EMBOLIZATION MATERIAL (Fig17)
There are many different types of embolization material,
some of which are not visible on x-rays.
They are placed through a catheter for the treatment of hypervascular tumors,
hemorrhages or arteriovenous malformations.
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) (Fig18)
It is the technique to reduce portal venous pressure by creating a shunt between the portal vein and one of the suprahepatic veins,
usually the right one.
The main indication is recurrent bleeding due to esophageal or gastric varices.
It is also used in Budd-Chiari syndrome,
in the hepatopulmonary syndrome and in gastropathy secondary to portal hypertension.
Complications: obstruction,
infection and hepatic encephalopathy