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 splenic flexure,
can also result in gastro-colo-cutaneous fistulae.
The diagnosis is made using contrast radiography via the PEG tube.
Small bowel,
liver and splenic injuries and possible intraperitoneal and retroperitoneal bleeding are reported but very rare complications.
Abdominal wall bleeding (i.e.
rectus sheath hematoma) following PEG placement is most often caused by puncture of an abdominal wall vessel,
it occurs soon after placement and it´s manifested by hemorrhage around the PEG insertion site.
Some of post-procedural complications are: peristomal pain,
abscess and wound infection,
necrotizing fasciitis,
peristomal leakage,
PEG site herniation,
GI bleeding and ulceration,
gastric outlet obstruction,
ileus and gastroparesis,
tumor implatation at PEG site,
etc.
In this educational exhibit we are focusing on buried bumper syndrome (BBS) and its imaging characteristics.
Buried bumper syndrome
Buried bumper syndrome is infrequent (occuring in 0.3-2.4 % patients) and usually late but very serious complication of PEG tube placement that can result in tube dysfunction,
gastric perforation,
bleeding,
peritonitis or death.
BBS occurs when the internal bumper of the PEG tube erodes into the gastric wall leading to ischemic necrosis and migration,
lodging itself anywhere between the gastric wall and skin,
causing variety of additional findings such as wound infection,
peritonitis and necrotizing fasciitis.
Obesity is considered as the most important risk factor although rapid weight gain,
patient manipulation,
gauze placement beneath the external bumper,
chronic cough and tube manipulation by inexperienced personnel have been associated with BBS.
Diagnosis of BBS is made clinically and usually confirmed endoscopically or with computed tomography.