September 21, 2009

Rectus Sheath Hematoma Following PEG Placement

Axial CT image of the abdomen shows a gastrostomy tube balloon (arrow) in the stomach. There is a hyperdense mass in the left rectus sheath (star).

Enteral Nutrition Options
  • Nasogastric tube: poorly tolerated by patients, difficult to maintain and increased risk of aspiration
  • Nasojejunal tube: better than NG tube but easily blocked
  • Gastrostomy tube -- can be placed surgically, radiologically or endoscopically
  • Jejunostomy tube: alternative to gastrostomy tube in patients with aspiration
Percutaneous Endoscopic Gastrostomy (PEG)
  • Placement of gastrostomy tube using the percutaneous approach and guided by concurrent endoscopy.
  • "Pull technique" most commonly used today
  • Patient is on conscious sedation
  • Endoscopy is used to find the optimal puncture site, using "finger pressure"

Indications for PEG
  • Need for enteral nutrition in patients unable to swallow
  • Provision of supplemental feeding or bile replacement
  • Gastric decompression in cases of chronic intestinal obstruction
Complications of PEG
  • Overall, 8% - 30%. Serious complications at approximately 1% - 4%
  • Pneumoperitoneum is frequently observed after PEG placement and is not regarded as a complication
  • Most frequent complication = local wound infection
Our case - left rectus sheath hematoma following PEG placement.

1. Loser C, Aschi G, Hebuterne X, et al. ESPEN guidelines on artificial enteral nutrition - percutaneous endoscopic gastrostomy (PEG). Clin Nutrition 2005;24:848-861.
2. Ponsky JL. Percutaneous endoscopic gastrostomy. J Gastroenterol Surg 2004;901-904.

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