Duodenal perforation secondary to gastrostomy tube migration: A case report

Abstract

Duodenal perforation secondary to gastrostomy tube migration is an uncommon but potentially life-threatening complication. This report aims to describe its clinical presentation, diagnostic assessment, and surgical management, highlighting the importance of recognizing abdominal symptoms after tube replacement. A 43-year-old woman with pulmonary lymphangitic carcinomatosis, extrinsic esophageal compression, dysphagia, and chronic malnutrition underwent surgical gastrostomy using a 22-French Foley catheter. Two months later, the catheter was replaced without complications. The following day, she developed abdominal pain. Noncontrast abdominal computed tomography demonstrated pneumoperitoneum, free intraperitoneal fluid, and the catheter tip within the duodenal bulb. Subsequent imaging with contrast administered through the gastrostomy tube revealed intraperitoneal extravasation, supporting the diagnosis of gastrointestinal perforation. Emergency exploratory laparotomy confirmed a perforation in the third portion of the duodenum, with contamination by gastric, biliary, and pancreatic contents. Surgical treatment comprised closure of the previous gastrostomy site, primary duodenal repair, pyloric cerclage, cholecystectomy, Roux-en-Y gastrojejunostomy, and feeding jejunostomy. Recovery was favorable, and the patient was discharged after approximately 15 days, tolerating jejunal enteral nutrition. This case underscores the need to suspect tube migration and duodenal injury when abdominal pain occurs after gastrostomy tube replacement. Early imaging assessment and timely intervention are essential to guide management. Surgical treatment should be individualized according to the injury and clinical context. Appropriate device selection, secure external fixation, and verification of tube position are important preventive measures, particularly when Foley catheters are used. The underlying malignancy remained the principal determinant of long-term prognosis.