Slipped and caught in the cecum: Endoscopic retrieval of a migrated foley feeding jejunostomy tube: A case report

Abstract

BACKGROUND

Foley catheters are occasionally used as feeding jejunostomy tubes, particularly in resource-limited settings. While enteral tube feeding offers significant benefits, it is not without its potential complications.

CASE SUMMARY

We present a case of distal migration of a Foley catheter used as a feeding jejunostomy tube in a patient with complete dysphagia due to esophageal malignancy. The tube, with its balloon lodged at the ileocecal valve, was successfully retrieved via colonoscopy, avoiding surgical intervention.

CONCLUSION

This case underscores the importance of device selection and secure fixation in enteral feeding to prevent tube migration, and highlights colonoscopy as a safe and minimally invasive solution for this rare complication.

Key Words: Foley catheter; Feeding jejunostomy; Enteral feeding complications; Tube migration; Distal migration; Small bowel obstruction; Ileocecal valve; Colonoscopy; Endoscopic retrieval; Resource-limited settings; Case report

Core Tip: Foley catheters are sometimes used as feeding jejunostomy tubes in resource limited settings, but their use carries a risk of distal migration due to inadequate fixation. This case highlights a rare complication in which a Foley catheter migrated distally with the balloon impacted at the ileocecal valve. Successful colonoscopic retrieval avoided surgical intervention, emphasizing the importance of appropriate device selection, secure tube fixation, and the role of colonoscopy as a safe, minimally invasive management option for migrated enteral feeding tubes.

INTRODUCTION

Enteral feeding via jejunostomy plays a vital role in managing patients with esophageal malignancy, particularly those undergoing radiation, chemotherapy or surgery, for maintaining nutritional status and improving the overall patient outcomes[1,2]. Dedicated jejunostomy tubes are preferred, however, Foley catheters are sometimes used as substitutes in resource-limited settings[3]. Although generally effective in the short term, Foley catheters carry unique risks due to their design and lack of secure external fixation. Possible complications include tube dislodgement, blockage and peristomal infection[4]. Distal migration of feeding tube is rare but warrants prompt recognition and intervention to prevent serious complications, including bowel obstruction, perforation, sepsis, and loss of nutritional access[5]. We report a case of distal migration of a Foley catheter, likely due to inadequate fixation, which became lodged at the ileocecal valve, appearing endoscopically within the cecal cup. The catheter was successfully retrieved endoscopically. Informed consent for the procedure and publication was obtained from the patient.

CASE PRESENTATION

Chief complaints

A 25-year-old female presented with abdominal pain and distension.

History of present illness

She presented with abdominal pain and distension. The Foley catheter was absent at the jejunostomy site.

History of past illness

The patient was a 25-year-old female with biopsy-proven gastroesophageal junction adenocarcinoma (T3N1), who had completed four cycles of chemotherapy and had negative laparoscopic staging for metastasis. She had previously undergone placement of a feeding jejunostomy for complete dysphagia. Due to resource limitations, a 16-French Foley catheter was used as a feeding jejunostomy tube. The catheter balloon was inflated with approximately 10 mL of sterile water, and the tube was secured externally using skin sutures without a dedicated fixation or external bolster device.

Personal and family history

Not mentioned.

Physical examination

On examination, she was tachycardic with a mildly tender, distended abdomen.

Laboratory examinations

Not mentioned.

Imaging examinations

Abdominal radiography revealed a long coiled tubular structure in the distal ileum with proximal small bowel dilatation, consistent with subacute small bowel obstruction.

FINAL DIAGNOSIS

Distal migration of a Foley catheter used as a feeding jejunostomy tube, with balloon impaction at the ileocecal valve causing near-complete luminal obstruction.

TREATMENT

Initial exploration with a pediatric colonoscope via the jejunostomy tract demonstrated normal jejunal mucosa and absence of the tube, suggesting distal migration (Figure 1A, Video). Colonoscopy revealed the Foley catheter balloon impacted at the ileocecal valve, causing near-complete luminal obstruction with surrounding mucosal ulceration (Figure 1B). The balloon was punctured using a 23-gauge injector needle, resulting in decompression and relief of obstruction (Figure 1C). One end of the catheter was noted to be twisted against the colonic wall; grasping forceps were used to disengage and straighten the catheter, after which it was successfully retrieved using a snare (Figures 1D and 2). Post-extraction inspection demonstrated localized ulceration at the ileocecal valve and focal mucosal ulceration in the terminal ileum due to pressure from the migrated tube, without evidence of perforation or active bleeding (Figure 3).

Figure 1 Colonoscope. A: Endoscopic view through the percutaneous jejunostomy tract demonstrating normal jejunal mucosa and absence of the Foley catheter, confirming distal migration beyond the jejunum; B: Colonoscopic view of the cecum showing the Foley catheter balloon impacted at the ileocecal valve, resulting in near-complete luminal obstruction with surrounding pressure-related mucosal ulceration; C: Balloon decompression achieved by puncture with a 23-gauge injector needle, relieving obstruction and allowing restoration of luminal patency; D: Colonoscopic view demonstrating torsion of the Foley catheter shaft against the colonic mucosa, contributing to difficulty in retrieval.

Figure 2 Sequential endoscopic retrieval maneuvers. A: Grasping forceps used to disengage and straighten the twisted catheter; B: Snare capture facilitating controlled extraction.

Figure 3 Post-retrieval findings. A: Localized ulceration at the ileocecal valve corresponding to the impaction site; B: Focal terminal ileal ulceration secondary to prolonged catheter contact, without perforation or active bleeding.

OUTCOME AND FOLLOW-UP

The patient remained clinically stable and had no post-procedural complications during one week of follow-up.

DISCUSSION

Distal migration of an enteral feeding tube is an uncommon but recognized complication, documented in only a few case reports[6,7]. Early detection is essential, as migration may result in bowel obstruction, perforation, sepsis, and loss of nutritional access[5]. The risk is increased when Foley catheters are repurposed for jejunal feeding due to their balloon-based internal fixation, lack of a secure external bolster, and susceptibility to balloon deflation or overinflation, which facilitates antegrade propulsion by intestinal peristalsis[8]. These mechanisms are well described when balloon catheters are used outside their intended purpose, and for this reason, non-balloon devices such as Malecot-type catheters are generally preferred for jejunal feeding.

Complications of feeding jejunostomies vary depending on technique and tube type, with mechanical problems such as kinking, malposition, and migration being relatively common[9]. Radiologic series report mechanical complications in approximately 19% of cases, while surgical reviews describe high overall complication rates, although only a minority require re-intervention[10]. True distal migration beyond the small bowel, however, remains rare.

Colonic migration is particularly uncommon, as most feeding tubes arrest within the small intestine. Extension into the right colon has been infrequently reported but may result in luminal obstruction and pressure-related mucosal ulceration. A limited number of reports describe successful colonoscopic retrieval using balloon deflation followed by snare removal, thereby avoiding surgical intervention. In our case, the Foley catheter balloon was impacted at the ileocecal valve and was successfully retrieved using this approach. In contrast, Ozben et al[11] reported failure of endoscopic removal due to severe kinking of the tube, necessitating partial dislodgement before spontaneous passage. Available evidence supports colonoscopic retrieval as a first-line strategy in clinically stable patients, as it reduces morbidity and healthcare costs.

Management strategies depend on the site of migration and the patient’s clinical status. Pereira and Mersich[12] described percutaneous aspiration of a Foley catheter balloon causing small bowel obstruction, which subsequently allowed colonoscopic removal from the sigmoid colon. Other reports have described the use of paraffin oil or liquid Vaseline to facilitate passage of migrated tubes[13]. Laxatives may be considered in asymptomatic colonic migration but should be avoided in small bowel migration, where they may exacerbate coiling and obstruction. Most authors attribute internal dislodgement to skin erosion at the insertion site and disruption of fixation sutures, which has been reported as early as two months following placement[14].

Previous reports of internal tube migration, including non-Foley devices, describe warning symptoms such as feeding failure, abdominal pain, and distension[15]. In resource-limited settings where Foley catheters continue to be used as temporary jejunostomy tubes, preventive measures include minimizing balloon volume, ensuring secure external fixation, regular position checks, caregiver education, and prompt imaging when migration is suspected. When colonic migration occurs without signs of peritonitis, colonoscopy with balloon deflation and snare retrieval represents a safe and effective first-line management option.

This case demonstrates that even an intact Foley catheter lodged at the ileocecal valve can be successfully retrieved endoscopically, avoiding surgical intervention. Attention to proper fixation, cautious balloon management, and regular monitoring remains essential to reduce the risk of distal migration.

CONCLUSION

Distal migration of a Foley feeding jejunostomy tube is a rare complication that can be safely and effectively managed by colonoscopic balloon deflation and retrieval, avoiding surgical intervention.