Retrograde pylorogastric intussusception: A rare complication of a ballooned gastrostomy device

An 8-month-old male with a low-profile ballooned gastrostomy device presented with a sudden onset of hematemesis. Upon upper gastrointestinal (GI) endoscopy, a 3-cm antral mass was identified, but the balloon of the gastrostomy device was not visualized in the stomach. The balloon was deflated for removal, and a new device was properly placed. The following upper GI radiographic series and magnetic resonance imaging studies suggested retrograde pylorogastric intussusception. During a second endoscopy, reduction was attempted unsuccessfully. Laparotomy was performed and Hutchinson's manual reduction was successful. Since the reduced pylorus had similar thickness to that of hypertrophic pyloric stenosis, pyloromyotomy was also performed. The patient was discharged one month after the operation with no signs or symptoms of intussusception. Retrograde pylorogastric intussusception is a rare complication of ballooned gastrostomy tube or device. The balloon migrated through the pylorus to the distal bowel. Tube manipulation and dense muscle layers of the pylorus might play major roles in causing retrograde intussusception and make spontaneous reduction difficult. It is important to choose and to anchor an appropriate gastrostomy device, with the appropriate stem length, to prevent distal migration of the balloon and retrograde intussusception.