Distal Migration of Percutaneous Endoscopic Gastrostomy Tube Causing Gastric Outlet Obstruction

An 80-year-old woman has been carrying percutaneous endoscopy gastrostomy (PEG) 20Fr for 3 years due to post-stroke dysphagia. She complains of 2 months of vomiting and recurrent abdominal pain. Analyses were unremarkable. Plain abdominal X-ray revealed hidroaereal levels and distention of the bowel loops. Abdominal CT showed concentric thickening of the antrum of oedematous nature, the PEG balloon at the duodenum first portion without pneumoperitoneum (Figure 1). The PEG was functional with easy rotation, but only with possible traction up to the 7 cm mark. After gastric content aspiration, the esophagogastroduodenoscopy showed duodenal migration of the PEG balloon causing gastric drainage obstruction (Figure 2) and duodenal bulb erosions by PEG balloon trauma. The PEG tube was repositioned at the level of the gastrocutaneous fistula after deflation of the balloon (Figure 3A) and then reinflated with 20 mL of distilled water. Additionally, a second external fixator was placed 3.5cm from the anterior abdominal wall to avoid recurrence of this complication (Figure 3B). No PEG migration recurrence was verified during 11 months of follow-up.