Learning objectives
to get familiar with indications and procedure of percutaneous endoscopic gastrostomy (PEG) tube placement,
to present possible procedure-related early and delayed complications that may occur accentuating imaging characteristics and
to introduce buried bumper syndrome by showing pictorial examples (what radiologist should know).
Background
Percutaneous endoscopic gastrostomy (PEG) provides a possibility of long-term enteral feeding to patients with neurologic deficits,
swallowing disorders,
patology of upper gastrointestinal/respiratory tract (oropharyngeal or esophageal tumors) and various hypercatabolic states (burns,
short bowel syndrome,
major traumas).
There are actually two main indications – feeding access and gut decompression in patients with advanced abdominal malignancies causing chronic obstruction/ileus.
There are few contraindications to PEG placement.
Absolute contraindications include pharyngeal or esophageal obstruction,
active coagulopathy and any other general contraindication to endoscopy.
Relative contraindications are: the...
Findings and procedure details
Complications
PEG complications can be divided into three groups:
complications of upper endoscopy,
direct complications of the PEG procedure and
post-procedural complications.
Complications associated with upper endoscopy include cardiopulmonary compromise (most frequent),
aspiration,
hemorrhage and esophageal perforation.
The most common but self-limiting PEG procedure-related complications is benign pneumoperitoneum (incidence of over 50 %).
Colon injury may occur due to the displacement of the transverse colon over the anterior gastric wall.
It usually presents with peritonitis and surgery is often required.
Interposition of bowel,
usually the...
Conclusion
The emergency physicians,
including radiologists,
should be aware of historical,
exam and imaging features that suggest buried bumper syndrome and distinguish it from other,
more benign complications.
Personal information
Ivana Kavelj,
MD
Radiology resident
Department of Radiology
UHC Sisters of Charity (KBC Sestre milosrdnice)
Vinogradska cesta 29
Zagreb 10000
Croatia
E-mail:
[email protected]
References
1.
Gauderer MWL,
Ponski J,
Izant RJ.,
Jr Gastrostomy without laparotomy: a percutaneous endoscopic technique.
J Pediatr Surg.
1980;15:872–875.
2.
Schrag SP,
Sharma R,
Jaik NP,
et al.
Complications related to percutaneous endoscopc gastrostomy (PEG) tubes.
A comprehensive clinical review.
J Gastrointestin Liver Dis.
2007;16(4):407–418.
3.Walter Geer,
DO and Rebecca Jeanmonod,
MD.Early Presentation of Buried Bumper Syndrome.West J Emerg Med.
2013 September; 14(5): 421–423.
4.Saptarshi Biswas,
Sujana Dontukurthy,
Mathew G.
Rosenzweig,
Ravi Kothuru,
and Sunil Abrol,
“Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal...