Complication of Percutaneous Endoscopic Gastrostomy (PEG) Necessitating Partial Gastrectomy

Percutaneous endoscopic gastrostomy (PEG) is a commonly performed procedure in patients with upper aerodigestive tract malignancies as well as in a range of other swallowing disorders. This is generally regarded as a safe intervention to enable long-term enteral feeding. The procedure is simple and quick to complete. Procedure related mortality is reported at around 1% and incidence of life threatening complications is low. We describe the management of a life threatening complication following gastrostomy tube insertion. A 68 year old Caucasian male was diagnosed with an advanced stage right supraglottic squamous cell carcinoma with metastasis to right neck. The patient underwent debulking of tumour and post-operative radical radiotherapy. To facilitate feeding, the patient required percutaneous endoscopic gastrostomy (PEG) tube insertion (15 Fresenius) which was accomplished without any difficulty. Six months after the insertion of PEG, the patient was admitted to the general surgeons with an acute abdomen. Investigations revealed displacement of the PEG tube with a perforated stomach. The patient required a laparotomy and partial gastrectomy. We conclude that the patients need to be thoroughly counselled about the possible complications related to PEG tube insertion. A high index of suspicion is required to identify PEG related peritonitis early to avoid any delay in its management.