Management of a Traumatic Gastric Ulcer With a Low-Profile Gastrostomy Tube

Duodenal perforation after gastrostomy tube replacement: Case report and literature review

Gastrostomy is commonly used to provide long-term enteral access for patients with feeding impairment. Routine replacement is a safe procedure, but it has various complications. We present a case of nasopharyngeal cancer, who visited the emergency department for gastrostomy tube dislodgement. Diffuse abdominal pain developed 3 days after replacement of the gastrostomy tube with a temporary silicone Foley tube. Emergency diagnostic laparoscopy was performed and found tip migration and causing duodenal perforation. Tip migration and compression necrosis of mucosa were the possible mechanisms. The condition was successfully treated by emergency laparoscopic duodenorrhaphy.

MDCT evaluation of complications of percutaneous gastrostomy tube placement

Percutaneous gastrostomy tube placement is a commonly performed procedure to provide enteral alimentation to patients unable to tolerate oral feeds. Percutaneous gastrostomy is a relatively safe procedure, and serious complications like gastrointestinal bleeding, perforated viscus, and adjacent organ injury are rare. The most common complications after gastrostomy tube placement occur early and are usually minor. The purpose of this review article is to describe the techniques of percutaneous gastrostomy tube insertion and imaging protocol for gastrostomy tube evaluation, and describe the early, late, and anytime complications. The article will also illustrate very rare late complications of gastrostomy tube placement like gastro-hepatic fistula, gastro-colic fistula, buried bumper syndrome, and gastrostomy site hernia.

Severe recurrent gastrointestinal bleeding following percutaneous endoscopic gastrostomy tube placement: a rare complication

Severe bleeding requiring blood transfusions following endoscopic, percutaneous gastrostomy tube placement is a rare complication. We describe a case of severe recurrent haemorrhage with bright red blood from rectum from endoscopic, percutaneous gastrostomy tube placement, which ultimately required removal of the percutaneous endoscopic gastrostomy tube.

Gastric Ulcer from the Pressure of a Gastrostomy Tube: A Rare Cause of Upper Gastrointestinal Bleeding

Gastrostomy tube placement is a well-known procedure for obtaining permanent enteral access and providing long-term nutritional support. Although it is usually well tolerated, a diverse array of complications can occur. A rare, and often unrecognized, complication of gastrostomy tube placement is upper gastrointestinal bleeding secondary to a gastric ulcer caused by pressure from a gastrostomy tube bumper or balloon. Here, we present a case of an elderly woman who experienced hematemesis and bleeding around the gastrostomy site. This report should alert healthcare staff that excessive tightening of the gastrostomy tube retainer or prolonged traction of the gastrostomy tube can cause pressure necrosis manifesting as gastric ulceration.

Percutaneous Endoscopic Gastrostomy: Mortality and Risk Factors for Survival

Background

The present study evaluated long-term risk factors for survival in patients who have undergone Percutaneous endoscopic Gastrostomy, as well as morbidity and mortality rates.

Methods

The retrospective study included 44 patients who underwent placement of a percutaneous endoscopic gastrostomy tube at various departments at Dicle University Medical Faculty between April 2008-September 2010.

Results

The study evaluated 23 women (52.3%) and 21 men (47.7%), with a median age of 50 ± 20 (17 - 87) years. Median time for Percutaneous endoscopic Gastrostomy placement was 23 ± 8.3 (5 - 45) minutes per patient. Total morbidity was 15.9%, including wound infection (4), tube occlusion (1), peristomal leakage (1), and abdominal wall bleeding (1). Short-term complications were not associated with albumin level (P = 0.312).The median hospital stay was 49.34 ± 60.99 (1 - 314) days. The mean follow-up period was 13.07 ± 13.12 (1 - 41) months. The above-normal level of albumin was found to be effective on survival (P = 0.024). Mortality occurred in 18 (40.9%) patients during the follow-up.

Conclusions

Percutaneous endoscopic Gastrostomy is both safe and effective in that it does not require surgical operation and it can be performed under surface anesthesia. The serum albumin level with patients who have undergone percutaneous endoscopic gastrostomyis an effective factor for survival.

Clinical investigation of upper gastrointestinal hemorrhage after percutaneous endoscopic gastrostomy

BACKGROUND

Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG.

PATIENTS AND METHODS

We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement.

RESULTS

Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement-related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement-related hemorrhage and one patient each with reflux esophagitis and gastric ulcer.

CONCLUSIONS

Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube.

Complications of a gastrostomy tube used for decompression of an inoperable bowel obstruction in a patient with advanced cancer

Percutaneous gastrostomy tubes (G-tubes) are used to decompress symptomatic patients with inoperable malignant bowel obstruction. Complications of G-tubes have rarely been reported in the palliative care literature. Nonetheless, complications are not uncommon and could interfere with the quality of life of patients, as illustrated by our case report. Given the increased use of percutaneous G-tubes, more attention needs to be paid to the prevention, early detection, and treatment of potential adverse events. Patients and their caregivers must receive appropriate education about complications of G-tubes and be made aware of the early signs and symptoms that must be brought to the attention of health care providers. Management of complications requires the use of health care resources that often can be found only in an acute care setting, and often requires referral to an interventional radiologist or endoscopist. Routine referral for G-tube placement before medical management has been maximized may not minimize suffering in patients with life-limiting illnesses.

Two case reports of gastric ulcer from pressure necrosis related to a rigid and taut percutaneous endoscopic gastrostomy bumper

Two complications are reported from excessively taut application of percutaneous endoscopic gastrostomy (PEG) external bumpers against the abdominal wall skin. First, a 55-year-old woman status post PEG developed a gastric ulcer, complicated by acute gastric bleeding, directly underneath the internal gastric PEG bumper. This complication was associated with replacement by an unknown healthcare worker of the standard flexible external (cutaneous) PEG bumper with an unauthorized rigid external clamp (bumper) and with excessively taut application of this clamp against the abdominal wall skin. No other causes or risk factors for gastric ulcers were present. The pathophysiology of this ulcer, similar to that of a decubitus ulcer, appears to be mucosal ischemia and pressure necrosis. Second, a 37-year-old man status post PEG developed a buried internal gastric bumper that caused PEG malfunction and abdominal pain from excessively taut application of the external PEG bumper. These case reports should alert healthcare workers that replacing a flexible external bumper with a rigid one and that tightening the external bumper excessively may cause pressure necrosis manifesting either as gastric or cutaneous ulcers or as a buried internal bumper. This alert is particularly important for nurses as they are likely to be the first healthcare workers to notice or be told of PEG failure because of their close involvement in the day-to-day care of the patient and their typically close rapport with the patient's family.