Unusual complication of a percutaneous gastrostomy tube

Abstract

Percutaneous Gastrostomy (PEG) tube is an endoscopic-guided procedure to provide enteral nutrition, medications and/or fluids to patients with oral or esophageal pathologies. PEG tubes are a relatively safe intervention but commonly known to have complications like insertion site infection, tube leakage, and tube blockage. This was an unusual case in which the PEG tube was discovered to be obstructing the third part of the duodenum after migration resulting in mechanical gastric obstruction with septic shock and severe hemodynamic instability. PEG induced gastric obstruction is often misdiagnosed during a triage due to the atypical presentation of this condition leading to aggressive management, testing and consultations. PEG dependent patients have rapidly increased over the years and a complete physical examination of the PEG site should be performed by all physicians in order to prevent related complications.

Keywords: PEG; aspiration pneumonia; jejunum; migration; obstruction; percutaneous gastrostomy tube; septic shock.

Figures

Figure 1.

Abdominal CT cross-section – gastrectomy tube in 3rd part of duodenal region.

Figure 2.

New 20 Fr MIC-type PEG tube inserted through old stoma and balloon inflated.