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).
Percutaneous endoscopic gastrostomy (PEG) provides a possibility of long-term enteral feeding to patients with neurologic deficits,
patology of upper gastrointestinal/respiratory tract (oropharyngeal or esophageal tumors) and various hypercatabolic states (burns,
short bowel syndrome,
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
PEG complications can be divided into three groups:
complications of upper endoscopy,
direct complications of the PEG procedure and
Complications associated with upper endoscopy include cardiopulmonary compromise (most frequent),
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,
The emergency physicians,
should be aware of historical,
exam and imaging features that suggest buried bumper syndrome and distinguish it from other,
more benign complications.
Department of Radiology
UHC Sisters of Charity (KBC Sestre milosrdnice)
Vinogradska cesta 29
Jr Gastrostomy without laparotomy: a percutaneous endoscopic technique.
J Pediatr Surg.
Complications related to percutaneous endoscopc gastrostomy (PEG) tubes.
A comprehensive clinical review.
J Gastrointestin Liver Dis.
DO and Rebecca Jeanmonod,
MD.Early Presentation of Buried Bumper Syndrome.West J Emerg Med.
2013 September; 14(5): 421–423.
and Sunil Abrol,
“Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal...