Button gastrostomy obstructing the ileocecal valve removed by colonoscopic retrieval

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Device Safety

Background:

• Fundoplication and gastrostomy tube placement are common procedures for feeding in patients with developmental disabilities.
• Gastrostomy buttons offer an alternative to traditional feeding tubes but pose unique risks.
• This case highlights a rare complication associated with gastrostomy button use.

Observation:

• A 16-year-old male with developmental disability presented with acute symptoms of abdominal obstruction, including retching, irritability, and distension.
• The patient had a history of fundoplication and gastrostomy tube placement, with a subsequent gastrostomy button missing from its stoma.
• Abdominal radiography revealed the dislodged gastrostomy button lodged at the ileocecal valve.

Findings:

• The dislodged gastrostomy button caused a significant small bowel obstruction.
• Conservative management with decompression and medical therapy failed to resolve the obstruction.
• Endoscopic retrieval of the gastrostomy button was successful and led to rapid symptom resolution.

Implications:

• Gastrostomy buttons, while beneficial, carry a risk of dislodgement and internal migration, potentially causing serious complications like bowel obstruction.
• This case underscores the importance of vigilant monitoring for dislodged devices in patients with gastrostomy buttons.
• Further research and potential design modifications of gastrostomy buttons may be necessary to enhance device security and prevent migration.