Unusual complications of ballooned feeding tubes

Percutaneous Endoscopic Gastrostomy (PEG) and Feeding Jejunostomy (FJ) with a Foley catheter are well-established techniques for providing long-term nutritional support. Mechanical complications of these procedures are well recognised. We report two unusual complications of feeding tubes related to the balloon. Patient 1: A 23 years old female cerebral palsy patient had a PEG tube changed to a ballooned gastrostomy tube. Following this she developed abdominal cramps, vomiting and later on haematemesis. Contrast study showed migration of the balloon causing pyloric obstruction and a small prepyloric ulcer. Partially deflating the balloon and pulling it back to the original position corrected this. Patient 2: A 39 years old male cerebral palsy patient with a Foley catheter feeding jejunostomy developed obstructive symptoms within 48 hours of surgery. The balloon was deflated repeatedly without resolution. The catheter was impossible to withdraw and irrigate. Contrast instilled via the balloon channel demonstrated that the catheter was significantly stretched and the balloon was in terminal ileum. The balloon was fully deflated and easily withdrawn to be replaced with uninflated Foley catheter. Enteral feeding was easily reestablished. If a patient with a ballooned feeding tube develops intestinal symptoms balloon complications should be suspected. Contrast study through the feeding channel or balloon inflation channel is useful in diagnosing tube related complication. The threshold for imaging should be low, particularly in patients who are difficult to assess clinically.