Gastrostomy Tube Migration Leading to Gastric Ulceration

Abstract

Introduction: Placement of a gastrostomy tube is indicated in select populations as a means of providing enteral nutrition. Although gastrostomy tube placement is routinely performed and considered a relatively safe procedure, several complications such as gastrointestinal bleeding and ulceration have been observed. Case Presentation: A 70-year-old Asian male presented with several episodes of black colored output from his gastrostomy tube over the preceding week. Associated symptoms included nausea, vomiting, and melena. His past medical history was significant for nasopharyngeal carcinoma requiring radiation therapy. The patient had residual dysphagia following radiation therapy and a gastrostomy tube placement. During his hospitalization, appropriate gastrostomy tube placement was confirmed using fluoroscopy. Given persistence of symptoms, the patient subsequently underwent endoscopic evaluation. The inflated balloon of the gastrostomy tube was noted to have migrated and became tethered at the level of pylorus (Figure 1). After mobilizing the balloon, a cratered non-bleeding ulcer was visible at the incisura (Figure 2, Figure 3). The gastric ulcer was a consequence of prolonged tension of the tubing leading to erosion of the gastric mucosa. The external tubing of the gastrostomy tube was pulled back and the external bumper was adjusted. The patient was started on a proton pump inhibitor and discharged home without complication. Discussion: We present a case of a gastric pressure ulcer occurring in the setting of gastrostomy tube migration. While gastric ulcers have been known to occur in patients with gastrostomy tubes, there have been few reports of ulceration occurring as a consequence of tube migration. This case demonstrates the importance of considering gastrostomy tube induced gastric ulcers in patients presenting with melena. Additionally, this highlights the importance of maintaining proper fitting of the gastrostomy tube to prevent tube migration and potential complications.3082_A Figure 1. Gastrostomy tube tethered at level of the pylorus3082_B Figure 2. Non-bleeding pressure ulcer at incisura3082_C Figure 3. Non-bleeding pressure ulcer at incisura