CASE REPORT
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.3–5
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Figure 1.: Axial CT image with intravenous contrast showing (A) PEG tube traveling through stomach and (B) inflated gastrostomy tube tip in the duodenal bulb with (C) compression of common bile duct. CT, computed tomography.
Figure 2.: Coronal CT image with intravenous contrast showing migrated gastrostomy tube tip in the duodenal bulb. CT, computed tomography.
Figure 3.: Upright abdominal X-ray showing correct repositioning of PEG tube visualized with the aid of contrast injection.
DISCLOSURES
Author contributions: H. Iqbal, H. Chaudhry, A. Rajan, and K. Khorfan reviewed the literature, drafted the manuscript, revised it for important intellectual content, and were involved in the final approval of the version to be published. J. Yang revised the article for important intellectual content and was involved in the final approval of the version to be published. H. Iqbal is the article guarantor.
Financial disclosure: None to report.
Informed consent was obtained for this case report.
REFERENCES
1. Fang JC, Lynch CR. Prevention and management of complications of percutaneous endoscopic gastrostomy (PEG) tubes. Pract Gastroenterol. 2004;28:66–77.
2. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: Indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739–51.
3. Taheri MR, Singh H, Duerksen DR. Peritonitis after gastrostomy tube replacement. J Parenter Enteral Nutr. 2011;35(1), 56–60.
4. Imamura H, Konagaya T, Hashimoto T, et al. Acute pancreatitis and cholangitis: A complication caused by a migrated gastrostomy tube. World J Gastroenterol. 2007;13(39):5285–7.
5. Yanagisawa W, Oh DD, Perera D, Rodrigues S. Acute obstructive pancreatitis secondary to migration of a gastrostomy tube into duodenum. Clin Case Rep. 2022;10(2):e05405.
