Gastric Outlet Obstruction Caused by PEG Tube Malposition: Contrasting Aspirates as a Diagnostic Clue

A 56-year-old man with spinocerebellar degeneration, managed at home with a percutaneous endoscopic gastrostomy (PEG) tube for 2 years, developed sudden abdominal distension without fever. PEG feeding had been well tolerated until the day before. On abdominal examination, tympanic sounds were noted on percussion, and vomiting occurred during evaluation. For decompression, aspiration was attempted through the PEG tube; however, the aspirate differed in color from the vomitus, and vomiting persisted despite drainage through the PEG tube. Therefore, a nasogastric (NG) tube was inserted, which yielded fluid of the same color as the vomitus. Aspiration through the PEG tube yielded bile-like yellow-green fluid, whereas nasogastric (NG) tube aspiration produced dark brown gastric contents (Figure 1). Abdominal computed tomography and endoscopy revealed that the PEG tube had migrated into the first portion of the duodenum (Figure 2). No signs of perforation or peritonitis were observed. Endoscopic repositioning of the PEG tube resulted in immediate resolution of symptoms. Gastric outlet obstruction (GOO) is an uncommon complication of PEG tube placement, typically caused by tube migration into the pylorus or proximal duodenum [1, 2]. In this case, visual inspection of aspirate appearance provided an accessible bedside clue to the diagnosis. This simple observation is particularly valuable in home care settings, where advanced imaging may not be readily available. Tatsuki Yamada: conceptualization; writing – original draft. Takashi Inaba: supervision; writing – review and editing. Ilsu Jon: writing – review and editing. The authors have nothing to report. Written informed consent was obtained from the patient to publish this article. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.