Barosa Rita, Santos Carla, Fonseca Jorge
Hospital Garcia de Orta, Hospital Garcia de Orta. Portugal, Portugal.
GENE - Enteral Feeding Team, Hospital Garcia de Orta. Portugal, Portugal.
Rev Esp Enferm Dig. 2016 Jan;108(1):53-4.
Dear Editor, A 75-year-old woman living in a nursing home presented with a 24-hour history of abdominal cramping and vomiting. Medical history was remarkable for dementia and a percutaneous endoscopic gastrostomy (PEG) was performed 3 years earlier. The day before the admission the feeding tube was accidentally pulled out and a Foley catheter was placed in order to avoid stoma closure. On physical examination, there was extravasation of the gastric content through the stoma. The base of the "Y" of the Foley catheter was introduced in the gastric stoma and a pulling sensation was felt when it was mobilized. The remainder abdominal examination was unremarkable. On esophagogastroduodenoscopy the Foley catheter was identified passing the pylorus and pulling duodenal bulb towards the antrum (Figure 1). Advancing the scope through the duodenum, the Foley balloon impacted in the duodenal apex was identified. There was no mucosal injury so the balloon was deflated and the catheter removed. A 14 Fr. Bard PEG tube was latter placed to allow a reduction in the calibre of the stoma. Gastric outlet obstruction is an unusual adverse event of PEG tubes. In adults it is usually related to Foley catheters use as peristalsis can pull the balloon into the duodenum in the absence of an external bumper. A clinical picture of abdominal cramping, vomiting and resistance to the attempt of percutaneous reposition should raise the suspicion of gastrostomy tube migration through the pylorus. Foley catheters are easily available and some may use it to prevent gastrostomy closure after accidentally PEG tube extraction. We have performed more than 800 PEG and assisted several cases of gastric outlet obstruction and even stoma damage in this setting. This case emphasises the importance of receiving an early PEG tube with external bumper replacement to prevent this adverse event.
一名居住在养老院的75岁女性，出现了24小时的腹部绞痛和呕吐症状。其病史以痴呆症为显著特征，3年前进行了经皮内镜下胃造口术（PEG）。入院前一天，饲管意外拔出，为避免造口闭合，置入了一根Foley导尿管。体格检查时，胃内容物经造口处外渗。将Foley导尿管“Y”形的底部置入胃造口，活动导尿管时能感觉到牵拉感。其余腹部检查未见异常。在食管胃十二指肠镜检查中，发现Foley导尿管通过幽门并将十二指肠球部拉向胃窦（图1）。将内镜推进至十二指肠，发现Foley球囊卡在十二指肠顶端。未发现黏膜损伤，于是将球囊放气并拔出导尿管。随后置入一根14 Fr.的巴德PEG管，以使造口口径缩小。胃出口梗阻是PEG管罕见的不良事件。在成人中，它通常与使用Foley导尿管有关，因为在没有外部缓冲装置的情况下，蠕动可将球囊拉入十二指肠。腹部绞痛、呕吐以及经皮重新定位尝试受阻的临床表现应引起对胃造口管经幽门迁移的怀疑。Foley导尿管容易获得，有些人可能会用它来防止PEG管意外拔出后胃造口闭合。我们已经进行了800多次PEG手术，并处理了几例这种情况下的胃出口梗阻甚至造口损伤病例。本病例强调了早期更换带有外部缓冲装置的PEG管以预防这种不良事件的重要性。
