Acute pancreatitis and cholangitis: a complication caused by a migrated gastrostomy tube.
Percutaneous endoscopic gastrostomy (PEG) is generally considered safe with a low rate of serious complications. However, dislocation of the PEG-tube into the duodenum can lead to serious complications. An 86-year old Japanese woman with PEG-tube feeding sometimes vomited after her family doctor replaced the PEG-tube without radiologic confirmation. At her hospitalization, she complained of severe tenderness at the epigastric region and the PEG-tube was drawn into the stomach. Imaging studies showed that the tip of PEG-tube with the inflated balloon was migrated into the second portion of the duodenum, suggesting that it might have obstructed the bile and pancreatic ducts, inducing cholangitis and pancreatitis. After the PEG-tube was replaced at the appropriate position, vomiting and abdominal tenderness improved dramatically and laboratory studies became normal immediately. Our case suggests that it is important to secure PEG-tube at the level of skin, especially after replacement.
Imamura
Hiroshi
H
Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, 21, Karimata, Yazako, Aichi-Gun, Aichi-Ken, Japan. imamurah@aichi-med-u.ac.jp
Konagaya
Toshihiro
T
Hashimoto
Takashi
T
Kasugai
Kunio
K
D000208:Acute Disease; D000369:Aged, 80 and over; D002761:Cholangitis / Q000175:diagnosis* / Q000209:etiology*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology*