Migrated PEG and free gas

Case contributed by Dr Jeremy Jones

Presentation

PEG tube inserted 3 days ago but increasing abdominal pain and tenderness in the epigastric area. Moderate rise in inflammatory markers since PEG tube insertion.

Patient Data

Age: 45
Gender: Male

Initial plain film

Modality: X-ray

Free subdiaphragmatic gas.

CT abdomen

Modality: CT

PEG balloon outwith the stomach and PEG-injected contrast in the peritoneal space adjacent to the right psoas.

Case Discussion

The PEG balloon sits anteriorly within the peritoneal space.  It is adjacent to the transverse colon and a loop of small bowel, but there appears to be no damage to the bowel itself.  Contrast injected into the PEG tube sits adjacent to the right psoas muscle in the peritoneal cavity.

Subsequent laparotomy confirmed that the PEG tube had been pulled through the stomach wall with the balloon inflated.  The defect in the stomach wall was closed.  No damage to the other loops of bowel.

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Case Information

rID: 14216
Case created: 7th Jul 2011
Last edited: 16th Oct 2015
Inclusion in quiz mode: Included

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