Dangers associated with replacement of a percutaneous endoscopic gastrostomy tube: Report of a case of skewering of the stomach into the jejunum like a bridge

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal disorders. Dislodgement, dysfunction, and infection are the reported complications associated with placement of a PEG tube. On the other hand, tract disruption and external displacement are the reported complications associated with replacement of a PEG tube. In all the external displacement cases following replacement of the PEG tube, the PEG tubes were displaced into the abdominal cavity. This is the first report of displacement of the PEG tube into the jejunum by accidental skewering of the tube through the stomach during its replacement. Case Report: An 85-year-old woman presented to our hospital complaining of erosive dermatitis around the PEG tube. Two weeks prior to her present complaints, the PEG tube had been changed, following which she developed erosive dermatitis around the PEG tube. Abdominal computed tomography (CT) and gastroendoscopy revealed that the PEG tube had gone through the anterior wall to the posterior wall of the stomach, like a “bridge,” and skewered out of the stomach. A new PEG tube was positioned in the stomach and the tract to the jejunum was treated conservatively. Conclusion: Although complications associated with replacement of the PEG tube are rare, replacement should be performed under gastroendoscopy to avoid these complications.