Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding

Abstract

Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.

Complication of dislodged gastrostomy Foley catheter: antegrade migration into small bowel

“…However, further review of the literature revealed several case studies detailing a number of unique complications arising from the use of Foley catheter in place of dedicated gastrostomy feeding tube 9–15. The common theme of the described complications is the distal migration of the Foley catheter balloon postpyloric into the small bowel.…”

“…Date et al reported the Foley balloon lodging in the pyloric channel, causing gastric outlet obstruction and a prepyloric ulcer 9. Once the balloon migrates past the pylorus, a number of complications including duodenal obstruction, duodenal ischaemia, upper GI bleeding, duodenojejunal intussusception and even obstructive jaundice have been described 11–14. Travelling further in the small bowel, the Foley balloon can again cause obstruction as described by Pereira and Mersich, who used percutaneous balloon aspiration as a minimally invasive method for relieving the obstruction 15…”

Intussusception: An anatomical perspective with review of the literature

“…JGI is defined as the prolapse of an anastomosed jejunum into the stomach (retrograde intussusception; Ibegbu et al, 2007). Since 1914, only 200 cases of JGIs have been reported in the literature (Samarasam et al, 2005;Miah et al, 2006).…”

Percutaneous Endoscopic and Radiologic Gastrostomy

“…Antibiotic prophylaxis is not necessary in patients already receiving appropriate broad-spectrum antibiotics around the time of the procedure, to lower the risk of Methicillin-Resistant Staphylococcus aureus (MRSA), which is commonly found in infected PEG sites (15,72). Some studies found beneficial results in pre-screening for MRSA (73,74).…”