Unusual complications of long-term percutaneous gastrostomy tubes

Abstract

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.

Does the placement of a FRECA gastrostomy at the time of laparoscopic fundoplication impact on outcome?

“…Simply cutting the PEG at skin level and allowing the internal hub to pass through the gastrointestinal tract is not an option as reported complications are significant. Described in this context are obstruction of the gastrointestinal tract, proximal migration with tracheooesophageal fistula, erosion of the retained hub with consequent enterocutaneous fistula, intra-abdominal abscess, and even death in some cases [8][9][10][11] Smaller and younger patients also constitute a higher risk for hub retention, making retrieval in this cohort mandatory [8].…”

An Unusual Case of a Ventral Richter’s Hernia at the Site of a Previous PEG Tube

“…Other common complications include benign post-PEG pneumoperitoneum and PEG tube deterioration or malfunction [7]. Unusual complications include inadvertent placement of the PEG tube through the intestine or liver resulting in peritonitis or bleeding, gastrocolic fistula formation, small-bowel erosion, or perforation caused by tube migration, separation of the internal bumper from the tube resulting in small-bowel obstruction, and buried bumper syndrome [8][9][10][11].…”

Duodenal perforation as a complication of gastrostomy tube migration

“…Gastrostomy tube migration is a known phenomenon that is predominantly associated with the use of balloon-type tubes without external bumpers and can result in complications such as gastric outlet obstruction, pancreatitis, small bowel obstruction, and even intestinal perforation. 4–7 Here, we report a rare case of gastrostomy tube migration resulting in duodenal perforation.…”