Presentation
Post a recent percutaneous endoscopic gastrostomy (PEG) tube insertion, presenting with pain and raised inflammatory markers with ongoing feed leakage at the insertion site.
Patient Data
A CT PEGogram with intravenous and on-table PEG contrast injection was performed. The PEG is extraluminal and appears to abut and indent the anterior gastric wall. There is a noted absence of gastric contrast with intra-abdominal and intrapelvic extravasated contrast on PEG contrast injection. There is free intraperitoneal air.
There is a chronic non-united left femoral neck fracture.
(Only the delayed series has been uploaded).
Image courtesy: Dr MG Magwai.
Case Discussion
The patient has a background history of multiple intracranial events and is bed-bound with dysphagia. A CT PEGogram was considered instead of the conventional dynamic fluoroscopic PEGogram or a static portable PEGogram, to assess for the presence of drainable collections and intra-abdominal abscesses in light of a septic picture and raised inflammatory markers.
Fortunately, there were no collections or abscesses for surgical or pigtail drainage, however, the PEG appeared extra-gastric and required a repeat insertion.
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