Ileal Obstruction: A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Insertion

Percutaneous endoscopic gastrostomy (PEG) is a widely used and generally safe method for establishing long-term enteral feeding. Bowel obstruction caused directly by the gastrostomy tube is a rare and easily overlooked complication, as the initial symptoms closely resemble ordinary feed intolerance. We report the case of a 55-year-old bedridden man with primary antiphospholipid syndrome and recurrent ischemic strokes who underwent uncomplicated PEG tube insertion for long-term nutritional support following aspiration pneumonia. Enteral feeding commenced the following day without difficulty. Ten days later, he developed recurrent vomiting and progressive feed intolerance. Plain CT of the abdomen demonstrated dilated small bowel loops consistent with obstruction. Subsequent contrast-enhanced CT identified a high-grade transition point in the ileum immediately adjacent to the PEG insertion site, with surrounding fibrotic tissue change. At surgical exploration using a hybrid laparoscopic-endoscopic approach, the gastrostomy tube was found to have eroded through an adherent loop of ileum, creating two full-thickness perforation sites in the bowel wall. The ileal defects were repaired primarily, the old tube retrieved endoscopically, and a new gastrostomy fashioned in the same operative sitting. The patient recovered without further vomiting, tolerated feeds through the revised tube, and follow-up contrast CT confirmed complete resolution of the obstruction. This case underscores that PEG-related bowel injury, while rare, should be considered in any patient who develops feed intolerance or vomiting following gastrostomy tube placement and does not settle quickly. Contrast-enhanced CT and prompt multidisciplinary surgical involvement are essential for timely diagnosis and a good outcome.