Open Access

The complications of percutaneous endoscopic gastrostomy

  • Julien Bordes1Email author,
  • Emmanuel Hornez2,
  • Nadia Kenane1,
  • Christophe Carrere3,
  • Yves Asencio1 and
  • Philippe Goutorbe1
Critical Care200812:422

https://doi.org/10.1186/cc6962

Published: 23 July 2008

Percutaneous endoscopic gastrostomy (PEG) has become the primary procedure for the long-term nutrition of patients with swallowing disorders. It has been shown to be an effective method with a lower complication rate than surgical placement [1]. It can be performed in the intensive care unit, but complications may occasionally occur. The estimated incidence of major complications is 8% [2]. Abscess and wound infections are the most frequent complications, but necrotizing fasciitis, colon or small bowel injuries, gastrocolic fistula, duodenal hematoma, liver injury, gastric perforation, and catheter migration have also been described [3]. Unexpectedly, acute hemorrhage following PEG is rarely reported. In the literature, we found only one case report of a fatal retroperitoneal hemorrhage occurring 2 hours after a PEG [4]. In a series of 263 cases, Schurink and colleagues [2] described only two cases of intra-abdominal bleeding.

A 59-year-old man was admitted to our hospital with intracerebral hemorrhage. On day 40, a PEG was performed in the intensive care unit using the 'pull' technique as previously described [5]. The needle puncture of the stomach was accomplished only on the second attempt, although the rest of the procedure was completed uneventfully. The material used was the Bard®Fastrac™ Pull PEG Kit (Bard Access Systems, Salt Lake City, USA). One hour after the end of the procedure, the patient presented a tachycardia (120 beats per minute), with cardiovascular collapse (arterial pressure 70/50 mmHg). Physical examination revealed a distended abdomen. The hemoglobin concentration was 5.5 g/dL. Abdominal echography showed the presence of intraperitonal liquid. An emergency laparotomy was performed, revealing a massive hemoperitoneum due to active bleeding from a small vessel of the minor curvature. X-sutures were applied and the bleeding stopped. A gastrostomy was recreated at the end of surgery.

The massive hemoperitoneum we described is a rare complication in relation to its rapidity and its severity. We think that the initial, unsuccessful passage of the needle could have caused the gastric artery branch laceration. Indeed, such a mechanism of injuries has already been suggested as an explanation for a fatal retroperitoneum due to breaches in the splenic and superior mesenteric veins [4]. In the patient we described, prompt recognition could minimize morbidity.

Although generally considered safe, PEG can be associated with life-threatening bleeding, especially when multiple needle punctures have been made. It presents with unexplained postprocedure hypotension. Intensivists who are used to performing PEG should be aware of this complication because early recognition and treatment are essential.

Acknowledgements

Written consent for publication was obtained from the patient's relatives.

Abbreviations

PEG: 

percutaneous endoscopic gastrostomy.

Declarations

Authors’ Affiliations

(1)
Department of Intensive Care, Sainte Anne Hospital, Boulevard Sainte Anne
(2)
Department of Visceral Surgery, Sainte Anne Hospital, Boulevard Sainte Anne
(3)
Department of Gastroenterology, Sainte Anne Hospital, Boulevard Sainte Anne

References

  1. Ljungdahl M, Sundbom M: Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc 2006, 20: 1248-1251. 10.1007/s00464-005-0757-6View ArticlePubMedGoogle Scholar
  2. Schurink CA, Tuynman H, Scholten P, Arjaans W, Klinkenberg-Knol EC, Meuwissen SG, Kuipers EJ: Percutaneous endoscopic gastrostomy: complications and suggestions to avoid them. Eur J Gastroenterol Hepatol 2001, 13: 819-823. 10.1097/00042737-200107000-00010View ArticlePubMedGoogle Scholar
  3. Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, Hoey BA, Stawicki SP: Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007, 16: 407-418.PubMedGoogle Scholar
  4. Lau G, Lai SH: Fatal retroperitoneal haemorrhage: an unusual complication of percutaneous endoscopic gastrostomy. Forensic Sci Int 2001, 116: 69-75. 10.1016/S0379-0738(00)00366-2View ArticlePubMedGoogle Scholar
  5. Gauderer MW, Ponsky JL, Izant RJ Jr: Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980, 15: 872-875. 10.1016/S0022-3468(80)80296-XView ArticlePubMedGoogle Scholar

Copyright

© BioMed Central Ltd 2008

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