Acute Pancreatitis Secondary to Migrated Gastrostomy Tube

Abstract

The aim of our study is to evaluate the pattern of acute pancreatitis due to the migration of Gastrostomy tube (GT). There were four cases of acute pancreatitis with a possible relation to migration of feeding tube. The diagnosis of acute pancreatitis was confirmed by significant elevation of serum Amylase and Lipase and CT scan findings of peri-pancreatic inflammatory changes. Clinical presentation, laboratory values, radiological findings and outcome of these patients were recorded. Initial symptoms were vomiting in two cases and abdominal pain and vomiting in another two cases. All four cases had a migrated GT balloon through the pylorus confirmed clinically or radiographically. Amylase and Lipase values were more than 10 times normal and values declined significantly within 24 hours of repositioning the feeding tube by pulling the balloon back into the stomach. Complete resolution of symptoms occurred within 48 hours after repositioning of the GT and intravenous hydration. Liver chemistries were within normal limits and there was no CT or sonographic evidence of intra or extra hepatic bile duct dilatation. Pancreas related complications were not observed in the four patients. However, two cases were complicated by pneumonia and urinary tract infection. All gastrostomy tubes were balloon type. In all cases, the initial physical exam done by the gastroenterologist revealed a migrated tube. Migration of gastrostomy tube through the pyloric channel may lead to acute pancreatitis. In this series, all cases were mild and responded to intravenous hydration and relocation of the balloon out of the duodenum and into the stomach. The cause for the development of acute pancreatitis can be the obstruction of ampulla of Vater or pancreatic duct by direct pressure of the migrated balloon. These cases could have been prevented by proper awareness of health care professionals or caretakers of physical signs of migrated feeding tube.