Pneumoperitoneum from an eroded T-fastener

Th, Ho; Margulies, Daniel R.

doi:10.1007/s004649900966

Cited by 10 publications

(7 citation statements)

References 2 publications

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“…This is again dependent on PEG tube design and ease of removal. Cases of major complications due to retained T-fasteners have been reported, including patent sinus tract formation around the fixation sutures resulting in pneumoperitoneum [20]. Therefore, the use of this fixation method also does not entirely prevent major complications after PEG tube placement and again does not prevent the major complication of PEG dislodgement itself.…”

Section: Discussionmentioning

confidence: 99%

Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system

et al. 2011

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Background Since its introduction in 1980, the percutaneous endoscopic gastrostomy (PEG) tube has become an efficient means of providing long-term enteral access. Conveniently, the soft inner bumper allows PEG removal with relatively minimal external traction. Consequently, a major complication is accidental dislodgement, from which significant morbidity may occur. Clinicians have perhaps underestimated and underappreciated this complication, not only in the acute setting but over the lifetime of the PEG tube. Methods A retrospective analysis of PEG placements conducted at the authors’ institution identified all PEG tubes placed between July 1, 2007 and July 1, 2010 by one faculty surgeon. Patient charts were reviewed for 30-day mortality, complications, and subsequent management. Patients were reviewed until intentional removal of the PEG, cessation of records, or patient mortality. Results A total of 563 PEGs were identified. The 30-day mortality rate was 7.8% (44/563), and the 7-day early accidental dislodgement rate was 4.1% (23/563). The total lifetime accidental PEG dislodgement rate was 12.8% (72/563). Of the 72 dislodged PEGs, 49 occurred after discharge from rehabilitation or nursing facilities. The vast majority required an emergency department visit, a level 3 surgical consultation, a replacement gastrostomy tube, and a radiographic confirmation of tube positioning, resulting in charges totaling an average of $1,200. Conclusion Many large PEG reviews report an early accidental dislodgement rate of 0.6% to 4.0%. The most clinically significant accidental removals occur in the first 7 days after placement, and open gastrostomy may cause obvious morbidity. The early dislodgement rate in this study (4.1%) is consistent with those currently reported. However, if cases are followed longitudinally, a significantly higher rate of late dislodgement (12.8%) is seen. Frequently placed into neurologically impaired or elderly patients, the PEGs that dislodge months and years later require expensive management. The late removal complication and its associated costs are overlooked and underestimated.

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Section: Discussionmentioning

confidence: 99%

Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system

et al. 2011

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“…The suture maintains adequate strength for wound closure until 3 weeks, becoming completely absorbed between 90 to 110 days. The advantage of an absorbable suture is that it does not have to be intentionally severed in follow-up and will not leave a permanent foreign body leading from the gastric lumen to the skin, which could serve as a nidus for fistula 11. Accordingly, we found that significantly more t-fasteners had detached and passed through the gastrointestinal tract in the long term compared to short term.…”

Section: Discussionmentioning

confidence: 73%

“…A single case report described the complication of intraperitoneal leakage of gastric contents due to a sinus tract caused by a nonabsorbable t-fastener suture 11. In this case, the gastrostomy tube was removed 3 weeks prior to presentation for an acute abdomen and the gastropexy had been performed 7 months prior.…”

Section: Discussionmentioning

confidence: 99%

T-Fastener Migration after Percutaneous Gastropexy for Transgastric Enteral Tube Insertion

Sydnor¹,

Schriber²,

Kim³

2014

Gut Liver

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Background/AimsTo determine the prevalence and time-course of t-fastener migration after gastropexy deployment.MethodsWe reviewed our procedural database for all percutaneous gastrostomy and gastrojejunostomy tube insertions performed over a 14-month period using a widely accepted t-fastener kit for gastropexy (Kimberly-Clark). Of 201 patients, 71 (41 males, 30 females; mean age, 56 years) underwent subsequent abdominal computed tomography (CT) imaging. The location and associated findings of each t-fastener were retrospectively recorded for each CT scan performed after the tube insertion.ResultsA total of 153 t-fasteners were deployed during 71 procedures with subsequent CT follow-up. In the short term (within 4 weeks after deployment), 5.1% of the t-fasteners had detached and were no longer present; 59.5% were intraluminal or within the gastric wall; and 35.5% were within the anterior abdominal wall musculature or subcutaneous. In the long term (>3 months), 48.6% of the t-fasteners had detached and were no longer present, 25.0% were intraluminal or within the gastric wall, and 26.4% were within the anterior abdominal wall musculature or subcutaneous. No t-fastener-related complications, such as abscesses, fluid collections, or fistulae, were identified.ConclusionsFollowing gastropexy for percutaneous transgastric feeding tube placement, t-fastener migration into the abdominal wall frequently occurred soon after the tube insertion. Therefore, recent t-fastener deployment does not guarantee an intact gastropexy.

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“…Although mostly innocuous, T-fasteners have been associated with major late complications. 8 While attempting to extract an old pull-throughtype gastrostomy tube, the internal head may get separated from a deteriorated stem and be retained within the stomach. This head can travel through the pylorus into the small bowel where it may become stuck and cause intestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Unusual complications of long-term percutaneous gastrostomy tubes

Bumpers

Collure

Best

et al. 2003

Journal of Gastrointestinal Surgery

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Percutaneous endoscopic gastrostomy (PEG) has been popular since it was introduced in 1980. Gastrostomy tubes left in place for long periods often result in unusual complications. Complications may also result from simply replacing a long-term indwelling tube. Five patients who had gastrostomy tubes in place for as long as 4 years are presented and their complications reviewed. Various methods used in treating these complications are discussed, and suggestions for their prevention are given. Gastrointestinal erosion and jejunal perforation following migration of the gastrostomy tube, persistent abdominal wall sinus tracts, and separation of the flange head with small bowel obstruction were encountered. Reinsertion of a gastrostomy tube through a tract prior to adequate maturation was also noted to lead to complications. Complications may result from gastrostomy tubes left in place for extended periods of time and during replacement procedures. Awareness of such complications along with education of caregivers and timely intervention by the endoscopist may prevent such occurrences. In some cases one can only hope to minimize morbidity.

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Pneumoperitoneum from an eroded T-fastener

Abstract: We present a case of late gastric perforation caused by retained T-fasteners after removal of a percutaneous endoscopic gastrostomy tube. We emphasize that timely removal of these fasteners is important in preventing this complication.

Cited by 10 publications

References 2 publications

Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system

Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system

T-Fastener Migration after Percutaneous Gastropexy for Transgastric Enteral Tube Insertion

Unusual complications of long-term percutaneous gastrostomy tubes

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