Purpose or Case Report: Gastrojejunostomy (GJ) tubes play an essential role in the management of individuals with poor gastric function, chronic vomiting and respiratory problems. Small-bowel intussusception around the GJ tube is uncommon with reported incidence of ~16% (likely to be higher in younger patients and with the use of large bore tubes). Complications associated with GJ tube intussusceptions are typically sub-acute and resolve spontaneously, but in some instances can lead to more severe complications such as bowel obstruction, ischemia and perforation.
Methods & Materials: GJ tube intussusception most often occurs in the duodenum which surrounds the jejunostomy limb of the GJ tube. While the precise mechanism is controversial, the available evidence suggests that the tip of the tube acts as a lead point causing either antegrade or retrograde intussusception. In addition to reliably making the diagnosis of GJ tube intussusception, identifying which type of intussusception has occurred can be important in guiding management.

Fluoroscopy has been the diagnostic modality of choice, however the techniques used vary widely amongst radiologists, and standardized terminology and diagnostic criteria are lacking. There is no consensus on the choice of enteric contrast material to use and also the choice of which port(s) to inject. Water-soluble contrast and barium have been used in isolation or in combination. Various combinations and sequences of single- or dual-port injections have been proposed. Fluoroscopy can demonstrate a so-called ‘coiled-spring sign’. Though this sign is pathognomonic for intussusception, transient peristaltic mimicker of this sign makes this determination difficult and the term is often used expansively to describe a variety of normal physiologic, as well as other abnormalities in the bowel that are not intussusception.
Most asymptomatic cases resolve on their own with conservative treatments. The majority of the symptomatic cases are managed by air or contrast reduction (only effective with retrograde intussusception), GJ tube exchange, or laparotomy.
Results:
Conclusions: GJ tube intussusception is a challenging radiologic diagnosis because of 1) poor understanding of pathophysiology, 2) lack of consensus on the fluoroscopic technique, 3) lack of standardized diagnostic criteria, and 4) unclear timing and management options. The goal of this educational paper is provide an overview of GJ tube intussusception, including potential mechanisms, diagnostic techniques and implications for management.