Unusual Case of Acute Pancreatitis Resulting from a Foley Catheter

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure for long-term enteral feeding, with procedure-related mortality rates as low as 0 to 2%. One of the complications after PEG tube placement is inadvertent tube removal, which occurs in 1.6 to 4.4% of cases. A Foley catheter (FC) is often placed temporarily by the emergency department or nursing facility to maintain gastrostomy tract patency. We report a case of acute pancreatitis in a patient with a FC balloon that migrated into the jejunum. Case presentation: A 59-year-old woman presented from a nursing home with acute-onset abdominal pain and vomiting. Her medical history was significant for traumatic brain injury, with resulting dysphagia leading to PEG tube placement. Several weeks prior to presentation, the gastrostomy tube was replaced by a FC due to inadvertent dislodgement. Physical exam at presentation revealed epigastric abdominal tenderness. The gastrostomy stoma showed no sign of erythema or infection, but the length of FC outside the patient's body was only approximately 10 cm. Laboratory studies showed elevated serum lipase of 5923 Units/L and a clinical diagnosis of pancreatitis was made. An upper abdominal ultrasound showed a normal gallbladder without cholelithiasis or bile duct dilation. Serum triglyceride level was normal. Abdominal CT with IV contrast revealed acute uncomplicated pancreatitis. The FC tip and a dilated balloon were seen in the proximal jejunum. Since no alternative cause of pancreatitis was found, it was postulated that due to FC's lack of an internal retention mechanism, distal migration of the balloon caused obstruction at the ampulla of Vater, resulting in acute pancreatitis. The balloon was deflated and the FC was repositioned so that the internal balloon was relocated to the stomach. When the patient clinically improved, an upper endoscopy was performed and the FC was replaced by a low profile gastrostomy button. Discussion: Acute pancreatitis is a rare complication after a FC is used to replace a standard gastrostomy tube. A FC should be substituted only on a temporary basis and active medical intervention should be sought to place a new gastrostomy tube. While the FC is in place, care should be taken to periodically inspect the length of tubing external to the body. In patients with temporary gastrostomy tubes, migrated catheters should be considered in the differential of patients presenting with acute pancreatitis.