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.