Perforation of an ileostomy by a retained percutaneous endoscopic gastrostomy (PEG) tube bumper

Abstract

Percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for long-term enteral feeding. Complications are generally infrequent and often avoidable. We describe an unusual case in which a PEG tube bumper caused subcutaneous perforation of an ileostomy. After conservative treatment proved unsuccessful, revision of the ileostomy via a peristomal incision was performed, with good result. Caution must be exercised before considering the severance of a PEG tube at the skin, especially in patients with an ileostomy.

Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review

“…A history of abdominal surgery was evident in 11 of the cases ( 9,10,12,13,20,25,26,28,31,35 ) but was not stated in 12 cases ( 11, 21-24, 27, 29, 30, 32, 33 ). One case reported no history of previous bowel surgery ( 34 ).…”

“…There were 21 records that reported complications post CP in 24 patients with a wide range of age and diagnosis (see Table One). Of these 15 were elective CP ( 12,13,20,21,(27)(28)(29)(30)(31)(32)(33)(34)(35) ); three were CP following failed traction removal of the PEG ( 11 22, 23 ); two were elective CP due to the inability to perform a gastroscopy secondary to oesophageal stricture ( 10,24 ).…”

“…The majority of complications occurred within six months or less with only three complications presenting after six months ( 10,24,26) . In many cases complications occurred within a month or less ( 9,13,20,21,23,27,28,31,(33)(34)(35) ).…”

Percutaneous Endoscopic Gastrostomy in Pediatric Patients

“…This is commonly performed in adult practice, but is generally thought to be unacceptable in children due to risks of esophageal and intestinal obstruction. Esophageal obstruction, perforation, mediastinitis, retropharyngeal abscess formation, gastric outlet, intestinal and ileostomy obstruction, enterocutaneous fistula formation, tract disruption and death have been variously described with PEG removal (Yaseen et al, 1996, Siegel and Douglass, 2004, Palmer et al, 2006, Mollitt et al, 1998, Lattuneddu et al, 2003, Kobak et al, 2000, El-Rifai et al, 2004. Traction removal is performed under general anesthesia in children and involves application of a significant pulling force to deliver the device in full.…”

Traction Removal of Percutaneous Endoscopic Gastrostomy Devices in Children

“…This is commonly performed in adult practice, but is generally thought to be unacceptable in children due to risks of esophageal and intestinal obstruction. Esophageal obstruction, perforation, mediastinitis, retropharyngeal abscess formation, gastric outlet, intestinal and ileostomy obstruction, enterocutaneous fistula formation, tract disruption and death have been variously described with PEG removal [6][7][8][9][10][11][12][13].…”