Laparoscopic management of early dislodgment of percutaneous endoscopic gastrostomy tube: a case report
EAES Academy. Lovitskyi Y. 07/05/22; 363090; P135
Ms. Yurii Lovitskyi
Contributions
Contributions
Abstract
Background:
Percutaneous endoscopic gastrostomy (PEG) tube placement is a preferred method of providing enteral nutritional support for patients who need it for three weeks and more, but can not take food per os. Early PEG dislodgement between postoperative day 0 and 7 occurs in <5% of cases and usually demands an emergent surgery by open approach.
Case presentation
A 48-years old male presented to emergency department with 6-hours history of worsening abdominal pain. 36 hours ago this patient with tongue cancer and subsequent dysphagia underwent PEG. Symptoms appeared after food had been induced into the tube. After gastrografin was injected in the PEG tube, abdominal computed tomography scans showed free air, fluid, extravasation of contrast, and migrated tube in the peritoneal cavity. Laparoscopic exploration confirmed gastrostomy tube dislodgment with diffuse secondary peritonitis. Abdominal cavity was irrigated, PEG tube was removed and a true Stamm gastrostomy was performed laparoscopically. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day.
Conclusions:
PEG dislodgement is rare, but easily diagnosed complication, which leads to secondary peritonitis and traditionally requires emergent open surgery. Early recognition and management of this state is crucial. Peritoneal cavity irrigation with gastrostomy tube replacement is a standard of care. Laparoscopic approach is safe and effective option if a recognition of PEG dislodgement is early.
Percutaneous endoscopic gastrostomy (PEG) tube placement is a preferred method of providing enteral nutritional support for patients who need it for three weeks and more, but can not take food per os. Early PEG dislodgement between postoperative day 0 and 7 occurs in <5% of cases and usually demands an emergent surgery by open approach.
Case presentation
A 48-years old male presented to emergency department with 6-hours history of worsening abdominal pain. 36 hours ago this patient with tongue cancer and subsequent dysphagia underwent PEG. Symptoms appeared after food had been induced into the tube. After gastrografin was injected in the PEG tube, abdominal computed tomography scans showed free air, fluid, extravasation of contrast, and migrated tube in the peritoneal cavity. Laparoscopic exploration confirmed gastrostomy tube dislodgment with diffuse secondary peritonitis. Abdominal cavity was irrigated, PEG tube was removed and a true Stamm gastrostomy was performed laparoscopically. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day.
Conclusions:
PEG dislodgement is rare, but easily diagnosed complication, which leads to secondary peritonitis and traditionally requires emergent open surgery. Early recognition and management of this state is crucial. Peritoneal cavity irrigation with gastrostomy tube replacement is a standard of care. Laparoscopic approach is safe and effective option if a recognition of PEG dislodgement is early.
Background:
Percutaneous endoscopic gastrostomy (PEG) tube placement is a preferred method of providing enteral nutritional support for patients who need it for three weeks and more, but can not take food per os. Early PEG dislodgement between postoperative day 0 and 7 occurs in <5% of cases and usually demands an emergent surgery by open approach.
Case presentation
A 48-years old male presented to emergency department with 6-hours history of worsening abdominal pain. 36 hours ago this patient with tongue cancer and subsequent dysphagia underwent PEG. Symptoms appeared after food had been induced into the tube. After gastrografin was injected in the PEG tube, abdominal computed tomography scans showed free air, fluid, extravasation of contrast, and migrated tube in the peritoneal cavity. Laparoscopic exploration confirmed gastrostomy tube dislodgment with diffuse secondary peritonitis. Abdominal cavity was irrigated, PEG tube was removed and a true Stamm gastrostomy was performed laparoscopically. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day.
Conclusions:
PEG dislodgement is rare, but easily diagnosed complication, which leads to secondary peritonitis and traditionally requires emergent open surgery. Early recognition and management of this state is crucial. Peritoneal cavity irrigation with gastrostomy tube replacement is a standard of care. Laparoscopic approach is safe and effective option if a recognition of PEG dislodgement is early.
Percutaneous endoscopic gastrostomy (PEG) tube placement is a preferred method of providing enteral nutritional support for patients who need it for three weeks and more, but can not take food per os. Early PEG dislodgement between postoperative day 0 and 7 occurs in <5% of cases and usually demands an emergent surgery by open approach.
Case presentation
A 48-years old male presented to emergency department with 6-hours history of worsening abdominal pain. 36 hours ago this patient with tongue cancer and subsequent dysphagia underwent PEG. Symptoms appeared after food had been induced into the tube. After gastrografin was injected in the PEG tube, abdominal computed tomography scans showed free air, fluid, extravasation of contrast, and migrated tube in the peritoneal cavity. Laparoscopic exploration confirmed gastrostomy tube dislodgment with diffuse secondary peritonitis. Abdominal cavity was irrigated, PEG tube was removed and a true Stamm gastrostomy was performed laparoscopically. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day.
Conclusions:
PEG dislodgement is rare, but easily diagnosed complication, which leads to secondary peritonitis and traditionally requires emergent open surgery. Early recognition and management of this state is crucial. Peritoneal cavity irrigation with gastrostomy tube replacement is a standard of care. Laparoscopic approach is safe and effective option if a recognition of PEG dislodgement is early.
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