Title: GASTRIC OUTLET OBSTRUCTION (GOO) DUE TO DISPLACED PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) TUBE
Abstract: PEG tube placement is widely used for enteral feeding. Major procedural complications are uncommon. An 84 year-old female nursing home resident with multiple medical problems had been receiving nutritional support for 8 months via a PEG tube following a cerebrovascular accident. When the PEG tube was accidentally pulled out, the nursing home staff promptly replaced it with a 20 Fr Foley catheter. No immediate complications were noted and tube feedings were continued successfully. Six weeks later, the patient developed abdominal cramping, mild bloating and frequent vomiting. No fever or chills were noted. Physical exam revealed normal bowel sounds; no abdominal distention, tenderness or guarding. The gastrostomy site had no ulcers or discharge. The external end of the Foley catheter was noted to have migrated and was close to the abdominal wall. The tube could be pulled back with minimal tension but upon release it recoiled back towards the abdominal wall. Abdominal X-ray revealed normal bowel gas pattern without distention or air fluid levels. The feedings were suspended. EGD revealed normal mucosa around the gastrostomy site. The Foley tube was seen to be coiled and had migrated beyond the pylorus into the duodenum. Upon intubation of the pylorus, the balloon was noted to be beyond the duodenal bulb and was still inflated. The balloon was deflated and the catheter was removed and replaced with a 22 Fr gastrostomy replacement tube. Tube feedings were then resumed without complication. Migration of feeding tubes has been reported and can cause GOO and intestinal obstruction. Ballooned tip tubes i.e. Foley catheter are often used as replacement PEG tubes and are prone to migration. Health care providers and family members of incapacitated patients with feeding tubes need to maintain a high degree of suspicion for this complication when difficulties in tube feeding are encountered.
Publication Year: 2004
Publication Date: 2004-10-01
Language: en
Type: article
Indexed In: ['crossref']
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