When Feeding Tubes Cause Biliary Disease: A Case of Acalculous Cholecystitis Due to Gastrostomy Tube Obstruction

Acute acalculous cholecystitis (AAC) is an inflammatory condition of the gallbladder that occurs in the absence of gallstones and is increasingly recognized among medically complex and long-term care populations. Patients receiving chronic enteral nutrition via gastrostomy tubes may be at risk for biliary complications related to impaired gallbladder emptying or mechanical factors. We describe an 81-year-old female nursing home resident with a previous medical history of hypertension, diabetes mellitus, Alzheimer’s dementia, hypothyroidism, and gastrostomy tube dependence who presented with five days of malaise, nausea, vomiting, and right upper quadrant pain. Laboratory evaluation demonstrated a cholestatic liver enzyme pattern without leukocytosis. Bedside ultrasonography revealed gallbladder dilation without gallstones. Contrast-enhanced computed tomography of the abdomen and pelvis demonstrated migration of the balloon-retained gastrostomy tube into the proximal duodenum, causing extrinsic compression of the distal common bile duct, with associated gallbladder distention and intra- and extrahepatic biliary dilatation. Magnetic resonance cholangiopancreatography confirmed obstructive physiology without choledocholithiasis. The gastrostomy tube was deflated, removed, and repositioned, resulting in rapid clinical and biochemical improvement with conservative management. In patients receiving long-term enteral nutrition, reduced physiologic gallbladder stimulation may predispose to bile stasis, creating vulnerability to obstruction when tube malposition occurs. Imaging plays a central role in diagnosis, and early recognition with prompt tube repositioning can reverse obstruction and prevent progression to more severe gallbladder injury. Clinicians should be aware that, in patients with gastrostomy tube dependence, unexplained cholestatic liver enzyme elevation should prompt assessment of tube position and evaluation for possible device-related biliary obstruction.