Introduction: Acute pancreatitis secondary to gastrostomy tube (G-tube) balloon migration is a rare complication. We present a case of acute pancreatitis secondary to G-tube placement in a patient with Roux-en-Y foregut anatomy. Case Report: A 33-year-old African American female presented with a one-day history of acute onset epigastric pain with associated fever (100.4F). Past surgical history was notable for Roux-en-Y gastric bypass and cholecystectomy. The patient had no prior history of alcohol use. Two weeks prior to admission, the patient underwent laparoscopic assisted transgastric ERCP for Type II SOD (dilated CBD and severe biliary pain) and was found to have severe papillary stenosis. Biliary sphincterotomy was performed and a G-tube was surgically placed into the excluded stomach for luminal decompression and maintenance of access. On admission, physical exam was notable for hypoactive bowel sounds with tenderness to palpation in the epigastrum, without peritoneal signs. G-tube was in place with minimal erythema at the incision site. Labs were notable for ALT 90U/L, AST 71U/L, alkaline phosphatase 125U/L, total bilirubin 0.7mg/dL, amylase 284U/L, and lipase 683U/L. CT abdomen revealed post-gastric bypass anatomy with the G-tube balloon extending into the second portion of the duodenum. The balloon was seen at the level of the ampulla, exerting a mass effect on the pancreatic head with associated moderate intra- and extra-hepatic biliary ductal dilatation and minimal pancreatic duct dilation. MRCP confirmed mass effect on the distal CBD by the G-tube balloon, with the CBD measuring 1.1cm. There was no filling defect identified in the biliary tree. The G-tube was retracted and balloon partially deflated, with resolution of symptoms and lab abnormalities. Discussion: G-tube placement has known complications including dislodgement, local hemorrhage, perforation, leakage at PEG site, and buried bumper syndrome. Acute pancreatitis secondary to a G-tube is a rare complication. Pancreatitis in this setting is more often caused by balloon migration of replacement tubes and/or Foley tubes, and not by the primary G-tube as seen in our patient. Symptoms typically resolve with medical management and changing/retracting the G-tube. Conclusions: Acute pancreatitis secondary to balloon migration of G-tubes is a rare complication. Increased awareness of this potentially serious complication is prudent, and should be considered as a potential etiology of pancreatitis in all patients with G-tubes. To the best of our knowledge, less than 10 such cases have been reported in the literature.
Read full abstract
Nov 1, 2014
Mm Taher + 2
Open Access
