A 78-year-old woman with a history of Crohn's disease and stroke returned to the emergency department 1 week after a percutaneous endoscopic gastrostomy (PEG) tube placement. She had presented 2 days earlier, because of vomiting associated with her tube feeds. At that point, her PEG was successfully aspirated and she tolerated feeds and was sent home. Today there is feculent material coming from the PEG tube and at the insertion site. The patient is unable to speak secondary to her stroke. Physical examination shows her vital signs are normal and her abdomen is warm, soft, nontender, and nondistended. The tube is difficult to aspirate today, but can be injected with some difficulty. A confirmatory x-ray with contrast is obtained (Figure).

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