Obstructive Pancreatitis Secondary to a Migrated Percutaneous Endoscopic Gastrostomy Bumper: A Rare Etiology

Abstract

A 64-year-old woman with traumatic brain injury and chronic percutaneous endoscopic gastrostomy (PEG) tube presented to the emergency room with nonradiating acute epigastric abdominal pain for 3 days. The external PEG bumper measured 8 cm. Lipase was 550 U/L (ref: 0-160 U/L), and abdominal computed tomography revealed migrated inflated PEG balloon into the duodenal bulb resulting in extrinsic mass effect on the pancreatic segment of the common bile duct with notable dilation of the common bile duct (Figures 1 and 2). The PEG tube was repositioned, and the bumper was adjusted to 4 cm. Abdominal X-ray showed the PEG balloon within the midgastric body (Figure 3). Her pancreatitis improved, and she was ultimately discharged. PEG tubes are commonly used for enteral nutrition in patients incapable of maintaining adequate oral intake and are generally safe and effective. 1,2 Complications of PEG include hemorrhage, infection, intestinal perforation, and peritonitis, whereas pancreatitis is rare and has only been reported sparingly. 3 The external bumper may dislodge, leading to tube migration, and therefore warrants frequent checks to ensure the bumper is firmly in place. 3,4 Resolution of symptoms in other cases occurred with tube repositioning, as seen in our patient. [3][4][5]

When a gastrostomy tube goes missing, acute bowel obstruction due to a migrated Foley catheter

“…Nonetheless, if there is no availability, a Foley catheter can be used to maintain the patency of the gastrostomy tract and, at the same time, be used as a feeding tube [ 6 ]. Nonetheless, a Foley catheter is not a gastrostomy tube, and it can develop even rarer complications such as migration, intestinal obstruction, and even pancreatitis [ 6 , 7 ]. These complications appear because these catheters do not have the external bumper to secure the tube to the abdominal skin, and they don’t have any marks that will help us measure the depth of the balloon [ 1 , 2 , 6 ].…”

“…These complications appear because these catheters do not have the external bumper to secure the tube to the abdominal skin, and they don’t have any marks that will help us measure the depth of the balloon [ 1 , 2 , 6 ]. Due to this, it’s recommended that Foley catheters only be used as temporary replacements when proper catheters are unavailable [ 7 ].…”

“…Migration is extremely rare and has been described in a few case reports in the English literature [ 7–9 ]. It is believed to happen due to the regular wear and tear caused to the external anchors, which makes them loose, allowing the catheter to migrate [ 8 ].…”

“…Therefore, regular check-ups and appropriate nurse training are needed to prevent this complication [ 9 ]. If migration happens, prompt medical attention is required as the tube can cause serious adverse events, such as gastric outlet obstruction, acute pancreatitis, obstructive jaundice, and small bowel obstruction with perforation [ 7 , 8 ]. Endoscopic treatment should be performed if the catheter is still in the stomach; however, surgery will be needed if severe complications appear [ 10 ].…”