Migrated PEG balloon causing acute pancreatitis

Percutaneous endoscopic gastrostomy (PEG) is a common procedure for an unsafe swallow or inability to maintain oral nutrition. When a PEG tube needs replacement, a balloon gastrostomy tube is usually placed through the same, well formed and mature tract without endoscopy. We present a patient with a rare complication related to the balloon gastrostomy tube, to raise awareness and minimise the risk of this complication in the future. A 67-year-old female patient presented to the emergency department with severe abdominal pain and vomiting. Her gastrostomy feeding tube displaced inwards, up to the feeding-balloon ports complex. After investigations, she was diagnosed with acute pancreatitis. MR cholangiopancreatography (MRCP) confirmed features of this and, interestingly, an inflated gastrostomy balloon could be seen abutting the major and minor ampullae. The patient confirmed that the PEG tube had been changed to a balloon gastrostomy tube some time ago, but the external fixation plate (external bumper) had been loose lately, with the tube repeatedly moving inwards. She admitted that, 1 day before admission, the PEG tube had receded into the stomach and could not be pulled out with a gentle tug. After reviewing the MRCP images, the balloon was deflated, and the tube retracted. Once correctly placed, the balloon was reinflated, and her symptoms improved over the next 2 days.