A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in children which cannot be treated without invasive procedures.

2nd Department of Internal Medicine Gastroenterology Charles University Faculty of Medicine in Hradec Králové University Hospital Hradec Králové Czech Republic

Department of Pediatric Surgery and Traumatology Charles University Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové Czech Republic

Department of Pediatrics Charles University Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové Czech Republic

Department of Radiology Charles University Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové Czech Republic

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