Emorragia e perforazione gastrica in paziente con gastrostomia endoscopica percutanea (PEG)

Abstract

Introduction: PEG is more and more used for those patients who need a medium and above all long term NE, especially domiciliary. This is the closest technical system to the requirements to have an ideal nutritional access; however it is burdened, on average in 32.5% of cases, with complications linked to technical mistakes of positioning or to a wrong management, as haemorrhage and gastric perforation.

Case report: A patient, subjected to supraglottic laringectomy, to removal of tongue’s base and to bilateral laterocervical lymphadenectomy and PEG carrier for 4 months, has arrived to our observation for a clinical outline of acute abdomen for perforation of empty internal organ, preceded by progressive anaemia due to high digestive haemorrhage. Performed an exploratory laparotomy, it was discovered on the gastric fore face, between body and antrum, in proximity to the small curvature and in front of the PEG gastric access, a perforation with max 2 cm of diameter, crossed by probe’s internal disk of retention. They were proceeded to remove that, to unstick the gastric stoma from the parietal peritoneum, to suture the access of gastrostomy and the perforation by omentoplasty. Finally they were carried out a jejunostomy for NE.

Discussion: We think we can pathogenetically identify the cause of the haemorrhage and of the stomach’s perforation, occurred in a short time in the case we have examined, in the probe’s movement for incorrect fixing of the plate of external anchorage or for excessive slimming of the patient due to not balanced nutritional supply, as well as in the consequent extension of its intraluminal part with continuous rubbing by internal disk on the gastric wall and with onset decubitus ulcer. Physiopathologic moments, connected with the supposed etiological factor, make both occurred complications as an unique pathologic entity, which has to be observed in the PEG carriers, in order to be able to diagnose it and treat it precociously and above all in order to be able to prevent it. Only a correct technique of positioning and of nursing and of management of nutritional supply is able not to thwart the finality of the PEG device which can be considered, in the elective indications and for the favourable requisites that marks it, a valid access to NE realization.