A large variety of foreign bodies are swallowed by children, but the majority, however, passes through the gastrointestinal tract without any adverse effects [1
]. The highest incidence of swallowed foreign bodies occurs in children between 6 months and 3 years, and coins are the most commonly ingested foreign bodies [3
]. Although 80% to 90% of swallowed foreign bodies will pass spontaneously, there is a definite predilection for swallowed foreign bodies to become stuck at the level of cricopharyngeus and just below it or at the esophagogastric junction [5
]. In our second patient and in spite of the large size of the swallowed foreign body, it passed with its plastic bag through the esophagus and into the stomach. In the stomach, the plastic bag opened, and to our surprise, the large foreign body passed through the pylorus to cause acute intestinal obstruction in the jejunum. The size of the jejunum is larger than that of the pylorus and duodenum and for this foreign body to pass through the pylorus; it should have passed through the whole small intestines to become stuck at the level of the ileocecal valve. We managed to milk it all the way through the small intestines and colon. The plastic bag stayed in the stomach and was removed via a small gastrostomy. The swallowed foreign body was not visible on plain abdominal X-rays, and it was a diagnostic dilemma for us. Although rare at this age, the possibility of a swallowed foreign body must always be kept in mind as a possible cause of acute intestinal obstruction.
Tube gastrostomy is one of the common operations performed for prolonged enteral feeding especially in neurologically impaired children. It is, however, associated with complications. Two common complications of tube gastrostomy are intraperitoneal leak leading to peritonitis and distal migration of the gastrostomy tube producing gastric outlet obstruction [6
]. Other rare and an unusual complications include perforation of the stomach, esophagus, duodenum, intussusceptions, and stomach prolapse at the gastrostomy site [8
]. In our patient, the gastrostomy tube was cut, and the distal part migrated passing through the pylorus to cause small bowel obstruction. The Foley's catheter, in spite of being cut, the balloon did not deflate and migrated intact to pass through the pylorus. The catheter's balloon did not deflate possibly because of manufacturing fault or improper storage. One way to obviate this complication is to use a button gastrostomy if available instead of Foley's catheter. This is also more convenient to the patients and parents.