Reflections in front of a case of ventral hernia after PEG tube removal

An Unusual Case of a Ventral Richter’s Hernia at the Site of a Previous PEG Tube

“…Recommendations to prevent hernia formation at PEG sites have included avoiding the linea alba, delaying removal of the PEG tube until the patient's nutritional status is optimized, avoiding excess tension on the PEG tube while it is place, and not engaging in excessive exercise in the time-period immediately post-PEG removal [12]. We support these recommendations and would add that additional caution should be taken in patients with a previous history of any type of abdominal hernia.…”

“…In that particular case, the patient presented with an abdominal wall defect in the area of the previous PEG tube 4 months after its removal and after intense physical exercise. The authors felt they had inserted the PEG through the linea alba, thereby providing a point of weakness in the abdominal wall predisposing to hernia formation [12]. There also is one reported case of gastric wall herniating through an existing PEG site as a result of traction on the stomach by the PEG tube.…”

Incisional Hernia After Percutaneous Endoscopic Gastrostomy Tube Placement: Importance of Avoiding the Linea Alba

“…The few articles on the subject have cited a multitude of possible reasons for the hernia, including strenuous physical activity, chronic cough, multiple PEG tubes placed successively through the same point on the abdominal wall, and the method of removal of the PEG tube. 3–7…”

“…1,2 The main purpose of this method is an attempt to avoid hollow viscus injury. 3 However, because patients have anatomical variance, this location on the abdominal wall will also vary. It is thus integral to have a comprehensive understanding of abdominal wall anatomy to avoid complications with appropriate placement.…”

Herniation through gastrostomy site: Case report

“…With the increasing numbers of PEG tubes being placed every year, it is expected that complications like these will gradually increase. Discussion of preventing this complication was presented by Boldo-Roda et al [2] and included avoidance of placement of PEG tube through linea alba, as this is an area of potential weakness; and possibly using cut and push technique rather than traction. It is possible that vigorous traction during removal may create a more permanent cavity than expected.…”