UNCOMMON COMPLICATIONS WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY - OUR EXPERIENCE
Abstract
INTRODUCTION
Percutaneous endoscopic gastrostomy
(PEG) is an alternative way to provide
tube feeding for patients without a laparotomy.
Although considered safe procedure,
immediate and delayed complications
have been described. These complications
vary from minor ones like
wound infections to major life threatening
complications like peritonitis and buried
bumper syndrome. We present a series
of uncommon complications related with
PEG placement experienced in our center.
CASE SERIES 1.A, 48 year old female
patient diagnosed to have carcinoma
tongue arrived at our department
with severe odynophagia and dysphagia.
Underwent PEG forlong term enteral nutrition
access. Developed infection at
stomal site. Imaging and endoscopy
showed internal bolster buried in to abdominal
wall. PEG tube was removed
immediately and managed conservatively.
Replacement PEG tube was
placed 3 weeks later following peristomal
wound site healing.2.54
year old male with head injury underwent
PEG for enteral nutrition, presented on 3rd
day with abdominal distension and absent
bowel sounds. He was suspected to have
post-procedural ileus and was managed
conservatively by bowel decompression
(PEG tube was kept open till bowel sounds
reappeared). PEG tube feeds restarted after
recovery.3.A 37 year old immunocompromised
male patient with AIDS and MDR
PTB developed tracheo-esophageal fistula,
underwent PEG for nutrition. 2 months later
presented with severe abdominal pain, fever
and necrotizing fasciitis around the
PEG site. PEG tube was in place in the
epigastricarea with signs of edema and
erythema around the PEG site on the abdominal
wall. Gastric contents were seen
leaking around the PEG site. He was
treated with parenteral broad spectrum antibiotics,
removal of PEG tube and debridement.
3 weeks later after intensive management
patient improved, PEG tube was
reinserted.CONCLUSIONPEG has become
the modality of choice for providing long
term nutrition. Though safe, it is associated
with significant complications.
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