A complication of T-fasteners in percutaneous endoscopic gastrostomy (PEG) placement

Abstract

Two patients with sinus tracts from retained T-fasteners following PEG tube placement are reported. Both patients had the PEG tubes subsequently removed and presented with purulent discharge and granulations near well-healed gastrostomy sites. The management of this complication and a possible method of prevention are discussed.

CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

“…Gastric wall tears were very rare complications. A similar case of anterior gastric wall injury occurred using a T-fastener [30]. We recommend the use of a gastropexy device to enable stabilization of the stomach during tube insertion and to prevent early leakage or tube dislodgement, which results in severe complications such as peritonitis or abdominal bleeding.…”

Pneumoperitoneum from an eroded T-fastener

“…This patient missed follow-up, allowing the permanent suture material to remain for 6 months. Sinus tract formation has been reported as a complication of retained sutures [2]; however, to our knowledge, there are no prior reports of an intraperitoneal leak caused by these fasteners.…”

Unusual complications of long-term percutaneous gastrostomy tubes

“…In such situations the sinus tracts need to be explored and the T-fasteners removed or the nylon sutures divided deep in the wound and removed. 7 If a metal T-fastener did not appear to be the nidus of infection, no attempt was made to remove it. The metal portion of the T-fasteners did not hinder healing once the nylon portion was removed.…”