A 57 year old woman with cerebrovascular disease had a 16 Fr Corflo percutaneous endoscopic gastrostomy (Merck Gastroenterology, West Drayton, Middlesex, UK) exchanged for a 20 Fr replacement Corflo balloon gastrostomy (volume 5 ml) as a bridge to eventual insertion of a permanent 20 Fr Corflo-cuBBy “button” gastrostomy. Four weeks later she presented with a seven day history of abdominal pain and vomiting. Initial investigations revealed a serum alanine transaminase level of 54 IU/l (normal range (NR) 0–35), serum alkaline phosphatase level of 491 IU/l (NR 70–300), serum bilirubin level of 7 …