Gastric Outlet and Duodenal Obstruction as a Complication of Migrated Gastrostomy Tube: Report of Two Cases and Literature Review

Abstract

Percutaneous endoscopic gastrostomy (PEG) is a well-recognized procedure for providing enteral feeding and long-term enteral nutritional support. Although it is mostly well tolerated, complications, sometimes mechanical in nature, do occur. Rare, and often initially unrecognized, late complications of PEG tube placement are gastric outlet obstruction and duodenal obstruction. Simple adjustment of the gastrostomy tube will lead to the improvement of the patient’s clinical condition and prevent further complications. Physicians should be aware of and suspect gastric outlet and duodenal obstruction as rare late complications of PEG tube placement. Simple adjustment of the gastrostomy tube can resolve the problem without unnecessary medical tests and overly aggressive care. Here, we present two interesting cases of elderly women who developed mechanical obstruction after inadvertent migration of the gastrostomy tube.

A case of neglected silicone tube in lacrimal duct for 20 years

“…Hence, a prolonged placement may cause complications easier, such as migration, occlusion, dislodging, and infection, all of which usually require replacement or removal of the tube within 1-year postoperative. 23 , 24 , 25 Compared to other types of exposed tubes, a lacrimal tube is completely isolated from the natural sterilization of the inner body, which might explain why the tube in the current case was tolerated for 2 decades. Silicone material, itself, has proved to be advantageous under harsh conditions, such as exposure to hydrochloric acid or irradiation, and biological inertness has been reported in the lacrimal duct using an animal model.…”

Unusual complication of a percutaneous gastrostomy tube

“…Placement of a PEG tube is usually a safe and a cost-effective method with low mortality for providing enteral nutrition [1]. Gastric obstruction most commonly occurs at initial placement of the PEG tube near the pylorus resulting in gastric outlet obstruction [2,3]. This was an unusual case in which PEG tube was discovered to have migrated far beyond pylorus of the duodenum obstructing the early parts of the jejunum resulting in mechanical gastric obstruction 6 months after the placement using a previous stoma.…”

“…Ideally, external fixator with 1-2 cm distance from the skin is recommended [3]. This should further involve adequate daily surveillance of the external fixator and tube mobility to ensure that the PEG tube has not migrated from the initial insertion measurement [2,4].…”

Gastric Ulcer from the Pressure of a Gastrostomy Tube: A Rare Cause of Upper Gastrointestinal Bleeding

“…In fact, despite the high success rate (>95%), major complications – those serious enough to require further intervention – have been reported in 0.4% to 4.4% of cases [ 2 ]. Some may occur immediately after gastrostomy tube placement and include pneumoperitoneum, esophageal, and gastric perforation, ileus, and injury to adjacent intra-abdominal organs, such as the liver and the colon [ 3 ]. Other potential complications tend to occur later on, after the gastrostomy tract has matured and include the deterioration of the gastrostomy site, buried bumper syndrome, and the formation of a colocutaneous fistula.…”