Small-bowel obstruction due to an intestinal balloon: treatment by percutaneous needle puncture.

A 1 7-year-old woman with cerebral palsy underwent anterior fusion and Harnngton rod placement for correction of scoliosis. Postoperatively the patient received enteric alimentation via a Keofeed (IVAC Corp., San Diego, CA) enteric tube (9.6 French, 1 09 cm) placed in the proximal jejunum. She suffered from intermittent feeding intolerance with increased gastric retention and bilious vomiting thereafter, which was treated conservatively. On the 45th postoperative day, she developed acute symptoms of abdominal distension and bilious vomiting. An attempt was made to exchange the feeding tube, which had been inserted 10 days before, but it could not be withdrawn. A supine abdominal film showed dilatation of the proximal small bowel and scattering of the metallic weights within the inflated weightbearing portion of the catheter. The inflated portion measured 4.5 x 3 cm on the film. Obstruction was confirmed by injection of water-soluble contrast material through the feeding tube (Fig. 1). A cross-table lateral film showed the inflated portion of the tube to be positioned just underneath the anterior abdominal wall without interposing intestinal loops. There were no clinical or laboratory signs or symptoms of peritonitis, so percutaneous transabdominal needle puncture of the balloon was performed under fluoroscopic guidance, by using a 22-gauge spinal needle. On passage of the needle, the balloon deflated instantaneously with an audible popping sound. The catheter was retrieved without difficulty, and the patient’s symptoms were relieved. Neither an immediate postprocedural abdominal film nor another taken on the following day showed pneumoperitoneum. Close inspection of the extracted catheter revealed a distended weight-bearing portion with greenish discoloration and an intact septum between the weightbearing portion and the tube.