Complication of PEG feeding tube
A 31-year-old woman with generalized dystonia, who developed dysphagia
and required oral supplementation via a (percutaneous endoscopically
inserted) gastrostomy. With her dystonic movements, she had several
tube displacements and the PEG had to be replaced on four occasions. On
the fourth occasion the balloon ruptured as the catheter was being
removed. She was then able to managed without tube supplements.
However, in the two months subsequent to the tube removal she had
persistant discharge of gastric contents from the PEG site. A probe
could be inserted throughout the length of the fistula tract. The
endoscopic photograph shows the site of the fistula - which has been
outlined by methylene blue injected at the skin surface. As no foreign
material could be seen endoscopically, the fistula tract was explored
and excised. The opened specimen shows the thickened, fibrotic tract
and remnants of balloon (coated in methylene blue). The arrow points to
the gastric end of the fistula.
Comment: On removal of a tube gastrostomy or tube jejunostomy, the tube
tract will invariably close over within a few hours. Failure to close
should make the clinician think, and remember the old surgical principle:
persistance of a fistula implies underlying disease - in this case, a foreign body.
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