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.

References:

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.