Percutaneous endoscopic gastrostomy (PEG) is a common procedure for an unsafe swallow or inability to maintain oral nutrition. When a PEG tube needs replacement, a balloon gastrostomy tube is usually placed through the same, well formed and mature tract without endoscopy. We present a patient with a rare complication related to the balloon gastrostomy tube, to raise awareness and minimise the risk of this complication in the future. A 67-year-old female patient presented to the emergency department with severe abdominal pain and vomiting. Her gastrostomy feeding tube displaced inwards, up to the feeding-balloon ports complex. After investigations, she was diagnosed with acute pancreatitis. MR cholangiopancreatography (MRCP) confirmed features of this and, interestingly, an inflated gastrostomy balloon could be seen abutting the major and minor ampullae. The patient confirmed that the PEG tube had been changed to a balloon gastrostomy tube some time ago, but the external fixation plate (external bumper) had been loose lately, with the tube repeatedly moving inwards. She admitted that, 1 day before admission, the PEG tube had receded into the stomach and could not be pulled out with a gentle tug. After reviewing the MRCP images, the balloon was deflated, and the tube retracted. Once correctly placed, the balloon was reinflated, and her symptoms improved over the next 2 days.

albumin supplementation (figure 1). Hepatic expression of TLR4 and associated pathways: Cirrhotic NAR animals had greater hepatic TLR4 expression which was reduced by albumin administration. Hepatic TLR4 gene array confirmed the activation of TLR4 dependent pathways in the cirrhotic NAR animals, which was abrogated by albumin infusion. Conclusion NAR animals have significantly greater liver injury, increased sensitivity to LPS and mortality which is prevented by albumin administration. Our data show for the first time that the mechanism of the protective effect of albumin is consequent upon restoration of gut junctional proteins and reduction of hepatic TLR4 expression.