Feeding Gastrostomy Foley Catheter Balloon Causing Duodenal Obstruction
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IMAGES IN SURGERY
Feeding Gastrostomy Foley Catheter Balloon Causing Duodenal Obstruction Harshit Agarwal 1 & Sushant Soren 2 & Pratyusha Priyadarshini 2 Received: 23 July 2020 / Accepted: 26 August 2020 # Association of Surgeons of India 2020
Abstract There are a varied number of complications of tube feeding. We present an image of duodenal obstruction caused due to migration of foley catheter balloon which was used as feeding gastrostomy. Keywords Gastrostomy . PEG . Obstruction
Tube feeding has been an integral part of the rehabilitation of vegetative patients after traumatic brain injury. Percutaneous endoscopic gastrostomy (PEG) feeding which was introduced in the 1980s has become a standard of care in such patients [1]. When utilized for a prolonged period, the clinicians often resort to the utilization of the Foley catheter as a PEG replacement tube, as it is cheap. However, it has its inherent complications. A 25-year-old male patient was brought by his relatives about 13 months after sustaining road traffic injury. At the index admission, he was diagnosed with traumatic brain injury and chest trauma. He was discharged with a tracheostomy tube and a PEG tube for enteral feeding. His PEG tube was replaced by a silicone Foley catheter about 2 months back. In this admission, he presented with complaints of bilious
* Pratyusha Priyadarshini [email protected] 1
Department of Trauma Surgery, KGMU, Lucknow, India
2
Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
vomiting, although he was passing faeces and was tolerating tube gastrostomy feeds. His nasogastric tube drained 1200 ml bilious output over 12 h. His electrolytes and complete blood count were within normal limits. A CECT abdomen was done with I.V. and oral contrast. It revealed an obstruction in the 4th part of the duodenum due to the inflated balloon of the Foley catheter, dilated duodenum and stomach with collapsed jejunum (Fig. 1). Small bowel obstruction due to migrating tubes has been described rarely. It happens due to the peristaltic propulsion of the tube [2, 3]. It can be easily prevented by fixing the catheter to the skin. Foley balloon was deflated and was pulled. Patient’s attendants were explained about the necessary care, and the patient was discharged on day 2 after bilious vomiting subsided.
Indian J Surg Fig. 1 a X-ray abdomen showing dilated stomach. b, c and d Axial, sagittal and coronal sections of CT Abdomen with contrast injected through tube gastrostomy. It shows Foley’s bulb inflated in 4th part of duodenum causing proximal obstruction
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Conflict of Interest The authors declare that they have no competing interests.
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References
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Thatcher BS, Ferguson DR, Paradis K (1984) Percutaneous endoscopic gastrostomy: a preferred method of feeding tube gastrostomy. Am J Gastroenterol 79(10)
Cassaday M, Kadakia SC,
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