UNCOMMON COMPLICATIONS WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY - OUR EXPERIENCE

INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) is an alternative way to provide tube feeding for patients without a laparotomy.Although considered safe procedure, immediate and delayed complications have been described. These complications vary from minor ones like wound infections to major life threatening complications like peritonitis and buried bumper syndrome. We present a series of uncommon complications related with PEG placement experienced in our center.CASE SERIES 1.A, 48 year old female patient diagnosed to have carcinoma tongue arrived at our department with severe odynophagia and dysphagia. Underwent PEG forlong term enteral nutrition access. Developed infection at stomal site. Imaging and endoscopy showed internal bolster buried in to abdominal wall. PEG tube was removed immediately and managed conservatively. Replacement PEG tube was placed 3 weeks later following peristomal wound site healing.2.54 year old male with head injury underwent PEG for enteral nutrition, presented on 3rd day with abdominal distension and absent bowel sounds. He was suspected to have post-procedural ileus and was managed conservatively by bowel decompression (PEG tube was kept open till bowel sounds reappeared). PEG tube feeds restarted after recovery.3.A 37 year old immunocompromised male patient with AIDS and MDR PTB developed tracheo-esophageal fistula, underwent PEG for nutrition. 2 months later presented with severe abdominal pain, fever and necrotizing fasciitis around the PEG site. PEG tube was in place in the epigastricarea with signs of edema and erythema around the PEG site on the abdominal wall. Gastric contents were seen leaking around the PEG site. He was treated with parenteral broad spectrum antibiotics, removal of PEG tube and debridement. 3 weeks later after intensive management patient improved, PEG tube was reinserted.CONCLUSIONPEG has become the modality of choice for providing long term nutrition. Though safe, it is associated with significant complications. An Initiative of The Tamil Nadu Dr. M.G.R. Medical University University Journal of Medicine and Medical Sciences Keyword :PERCUTANEOUS ENDOSCOPIC GASTROSTOMY,BURIED BUMPER SYNDROME, ILEUS, NECROTIZING FASCIITIS. INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 by Ponsky and Gauderer as an alternative way to provide tube feeding for patients without a lapar otomy(1,2).It is considered as the modality of choice for long-term enteral access to variety of patients including those with neurologic deficits and swallowing disorder and those with oropharyngeal or esophageal tumors and various hypercatabolic states like burns, short bowel syndrome, and major traumas. PEG tubes have two main indications ? feeding accessand gut decompression(3). Absolute contraindications to PEG placement include pharyngeal or esophageal obstruction, active coagulopathy and any other general contraindication to endoscopy. Despite its good safety record, PEG can be associated with significant complications. These complications vary from minor ones like wound infections to major life threatening complications like peritonitis and buried bumper syndrome (4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, At our center a total of 25