Which of the following is a life-threatening etiology of pain after starting bolus feeds via a G-tube?

• A. Presence of infection
• B. Pressure necrosis
• C. Intraperitoneal leakage
• D. Gastric ulcer

Answer: (D)

Pain after starting bolus feeds through a gastrostomy tube can signal a serious problem with the stomach lining. A gastric ulcer is particularly dangerous because if an ulcer erodes through the stomach wall, it can perforate, letting gastric contents spill into the peritoneal cavity and cause peritonitis and shock—life-threatening conditions that require urgent care. Bolus feeding increases gastric volume and acid exposure, which can worsen an existing ulcer and precipitate perforation or major bleeding. While infection, pressure necrosis, or intraperitoneal leakage can be serious, the potential for a perforated ulcer causing an acute abdomen makes gastric ulcers the most worrisome, life-threatening etiology in this scenario. If such pain occurs, stop feeds, assess for peritonitis, obtain imaging, and involve urgent medical or surgical evaluation.