Proximal Migration of Jejunostomy Extension Tube Causing Recurrent Aspiration

A 67-year old woman presented with worsening dyspnea, productive cough, and fever. She denied oral intake, and her symptoms were worse with tube feeds. Her medical history was significant for chronic obstructive pulmonary disease, gastric esophageal reflux disease (GERD), and severe oropharyngeal dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube with jejunal extension placement one year prior. Physical exam was notable for bilateral end expiratory wheezes with right-sided basilar rales on auscultation of the lungs. PEG insertion site looked clean with no signs of infection or abnormal drainage. Chest x-ray showed right lower-lobe consolidation. Blood and sputum cultures were obtained and broad-spectrum empiric antibiotic coverage was initiated for a diagnosis of aspiration pneumonia.