Discussion
Gastrostomy tubes are increasingly being utilised to facilitate patients
with no or minimal oral intake. Complication rates from G-tubes are
known to be low, including bleeding, infection, formation of granulation
tissue and tube blockage 4. In particular, acute
obstructive pancreatitis due to obstruction of major duodenal papilla
are rare and infrequently reported in literature, and in Australian
literature, none yet published. To our knowledge, there are limited
reports of acute pancreatitis caused by PEG tube migration reported
internationally as well 3-5. Migration has been
associated with Foley catheter usage, using tubes without external
bumpers or not performing radiological confirmation 6.
Only one study performed an Endoscopic Retrograde
Cholangiopancreatography (ERCP) to rule out other ductal pathology apart
from the PEG tube. In our case, an MRCP was performed to ensure no other
cause for pancreatitis could be determined. According to available
literature, majority of known cases of PEG tube pancreatitis were due to
the use of foley catheters, which have increased propensity to migrate
due to external bumper dislocation.5 This case adds to
the existing literature about lack of imaging following re-insertion of
a gastrostomy tube as another potential contributing factor for
iatrogenic pancreatitis. We have demonstrated that the appropriate
management of pancreatitis secondary to PEG tube is to deflate the
balloon and withdraw the tube, followed by repeating imaging to confirm
appropriate positioning of the balloon. This management resulted in the
patient’s prompt recovery. It is still imperative that other more common
causes of pancreatitis are investigated for, and the diagnosis of PEG
tube migration being the cause of pancreatitis is one of exclusion.