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You are seeing a 2-year-old girl that had a PEG gastrostomy tube placed 1.5 years ago. The parents have noticed resistance when pushing in the bolus feeds, as well as increased leakage around the stoma site. The child seems to have pain and tenderness in the peristomal area, although there is no fever, redness, or purulent discharge. The tube is difficult to move or rotate. 

What is the most likely cause of the child’s symptoms?