Wisam Sbeit, Nimer Assy, Anas Kadah, Moaad Farraj, Masad Barhoum,Marian Musa, Moshe Shiller
Percutaneous endoscopic gastrostomy has become the preferred method to provide nutritional support for patients requiring long term enteral feeding due to its ease and safety of placement. The estimated prevalence is about 18-34% among nursing home residents with advanced cognitive impairment. Complications of percutaneous endoscopic gastrostomy placement may be minor or major but the most are minor with average rates of 16-70% in different reports. Procedure related mortality rate is 0-0.2%. In this paper we present a case of 46 nursing home resident who was fed through percutaneous endoscopic gastrostomy for several years which was replaced by Foley catheter due to accidental dislodgement of the tube several weeks ago. She was admitted to internal medicine ward for black colored vomiting and impacted nonfunctional Foley catheter. Vital signs were normal at her admission and abdominal tenderness at the epigastric region was found. Blood tests revealed elevated Liver Enzymes and elevated LIPASE X 8 of upper Normal limit. She was diagnosed with pancreatitis and treated with NPO and IV Saline. Abdominal computed tomography revealed dilated gall bladder, with prominent Wirsung and common bile ducts and a peripancreatic fluid around the pancreatic tail. A replaced catheter tip was seen in the descending duodenum with no evidence of bowel obstruction. Fluoroscopy showed contrast in the small bowel with feeding tube tip in the same region. Gastroscopy revealed migration of the Foley catheter distally to the second portion of the duodenum with catheter balloon stuck to the major papilla causing a pressure ulcer in the papilla. The balloon was deflated and the catheter was replaced by balloon replacement tube gastrostomy. Biopsies taken from the ulcerated papilla showed ulcerated small bowel mucosa with acute and chronic inflammatory cells. Two days later, enteral feeding and her chronic medications were resumed with no complications and she was disharged home. Received December
