A Case of Difficult Management of a Gastrostomy Placed Near the Pylorus

Abstract

Gastrostomy is a well-established solution for long-term nutrition management in patients with difficulty in oral intake of food. Although it significantly improves the quality of life, various associated complications have been reported, especially in pediatric patients. In this paper, we present the case of a child with a gastrostomy placed next to the pylorus, who experienced repeated hospitalizations due to complications arising from her condition. A 10-year-old girl with developmental delay and gastroesophageal reflux disease had a gastrostomy placed at 10 months of age owing to difficulty in oral intake associated with low birth weight and cerebral palsy. She experienced respiratory symptoms and poor weight gain, leading to her referral to our pediatric department. Thereafter, she underwent several adjustments to her gastrostomy and changes in her nutritional management, including the creation of a colostomy due to ileus. Despite these interventions, she still experienced recurrent nausea and gastric dilation. She also developed bumper buried syndrome, a rare complication where the internal bumper of the gastric fistula becomes embedded in the gastric wall. Eventually, the gastric fistula was repositioned away from the pylorus, which improved her condition and allowed for steady weight gain. This case underscores the need for careful monitoring and timely adjustments in the management of gastrostomy in pediatric patients.