A 44-year-old man residing in a nursing home was receiving enteral nutrition through percutaneous endoscopic gastrostomy (PEG) after suffering an embolism 2 years earlier. He accidentally pulled out his feeding tube. In order to prevent closure of the gastrostomy, a Foley catheter was immediately put in place. Several hours later the patient presented with vomiting. The next day, after the administration of methylene blue through the catheter, the patient underwent an endoscopy, which revealed that the Foley catheter had passed into the pyloric antrum (fig. 1), with the balloon migrating into the duodenum (fig. 2), causing partial obstruction (fig. 3).

Figure 1.

The Foley catheter progressing through the antrum.

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Figure 2.

The catheter crosses the pylorus migrating into the duodenum.

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Figure 3.

Partial obstruction of the duodenum.

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The catheter was removed, a 20F Bard® PEG tube was inserted, and the obstruction was resolved. In cases of accidental PEG tube extraction, Foley catheters are frequently used to prevent gastrostomy closure because they are easily passed through the gastrostomy and they are available at the majority of health facilities. However, they do not have an external bumper and peristalsis can pull the balloon into the duodenum, causing gastric outlet obstruction. Rather than having Foley catheter insertion, patients should be rapidly referred to a hospital center within the first 24h so that a PEG tube can be adequately placed. If early referral is impossible, the Foley balloon should be minimally inflated to prevent migration into the duodenum and gastric outlet obstruction (figs. 1–3).