An unintended path: Foley catheter-induced biliary obstruction following gastrostomy tube replacement - A case report

Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for long-term enteral access. Accidental dislodgement is a relatively common occurrence, and in many settings a Foley catheter is inserted as a temporary measure to preserve tract patency until definitive replacement can be performed. Although this practice is routinely employed, Foley catheters lack an external flange and are therefore susceptible to distal migration and associated complications. We describe a case of a 97-year-old woman with advanced dementia who presented to the emergency department with recurrent vomiting and coffee-ground material in her gastrostomy drainage bag after her PEG tube had been replaced with a Foley catheter at a nursing facility. Laboratory evaluation revealed cholestatic liver enzyme elevation, and imaging demonstrated distal migration of the catheter with balloon compression of the distal common bile duct, resulting in obstructive biliary pathology. Repositioning of the Foley catheter and delayed reinsertion of a dedicated PEG tube led to prompt clinical improvement. This case illustrates an underrecognized complication of temporary gastrostomy substitutes and emphasizes the importance of considering catheter migration in patients presenting with unexplained gastrointestinal or biliary symptoms after recent tube replacement. Preventive strategies including external marking, temporary securement measures, and routine radiologic confirmation of tube position may reduce morbidity and avoid unnecessary diagnostic evaluations.