Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement

Abstract

A 53-year-old man with dysphagia underwent uneventful placement of a percutaneous endoscopic gastrostomy (PEG) tube for long-term enteral feeding access. 11 hours after the procedure, it was discovered that he had accidentally dislodged the feeding tube. On physical examination, he was found to have a benign abdomen without evidence of peritonitis or sepsis. He was observed overnight with serial abdominal examinations and nasogastric decompression. In the morning, he was taken back to the endoscopy suite where endoscopic clips were employed to close the gastric wall defect and a PEG tube was replaced at an adjacent site. The patient was fed 24 hours thereafter and discharged from the hospital 48 hours after the procedure. Early accidental removal of a PEG tube in patients without sepsis or peritonitis can be safely treated with simultaneous endoscopic closure of the gastrotomy and PEG tube replacement, resulting in earlier enteral feeding and shorter hospital stay.

Managing a Gastrocolocutaneous Fistula with Delayed Presentation after PEG Placement without Surgery

“…If the patient is symptomatic with signs of sepsis or peritonitis then removal of the PEG and surgical repair of both the stomach and the colon may be indicated. Other studies also suggest that these injuries may also be repaired or clipped endoscopically [4,5,7]. In our experience, the presence of free air and signs of bowel obstruction were very concerning for malpositioning of the gastrostomy, however, all imaging modalities were negative for any findings that suggested this feared complication.…”

Loose PEG Tube Leading to Peristomal Leakage and Peritonitis, a Case Report

“…2 If active leakage is identified after contrast studies in a patient with clinical signs of peritonitis, surgical exploration and broad-spectrum antibiotics are indicated. 2,6,7 Although CT is a more sensitive and specific examination for evaluating free air and bowel perforation than chest X-ray, chest X-ray can be obtained more quickly. If there is clinical suspicion of peritonitis or bowel perforation, an upright CXR should be obtained as an initial imaging study.…”

Loose PEG Tube Leading to Peristomal Leakage and Peritonitis, a Case Report

“… 2 If active leakage is identified after contrast studies in a patient with clinical signs of peritonitis, surgical exploration and broad-spectrum antibiotics are indicated. 2 , 6 , 7 …”