A Knotted Elemental Diet Tube in a Neonate: Serial Radiographs Demonstrating the Process of Loop Formation

Abstract

A 1-day-old girl with a congenital hepatoblastoma (diameter 89 mm) placed in the right hepatic lobe was admitted to our neonatal intensive care unit. Nasogastric tube feeding was initiated; however, delayed gastric emptying, possibly due to an outlet obstruction caused by the tumor, prompted us to insert a polyvinyl-chloride elemental diet (ED) tube (6.5F/120 cm; Covidien, Tokyo, Japan). The distal end of the ED tube was located at the duodenum on the 24 hospital day (Figure 1A). Radiography on the 27 hospital day indicated that the tube had slipped out from the pylorus (Figure 1B). We expected that the tube would pass through the pylorus again; however, the radiograph suggested that it formed a loop (Figure 1C) in the stomach 7