Fatal retroperitoneal haemorrhage: an unusual complication of percutaneous endoscopic gastrostomy.
A 93-year-old lady with dementia, neurological dysphagia and aspiration pneumonia, died from massive retroperitoneal haemorrhage which developed as a rare and, it is believed, hitherto unreported, complication of percutaneous endoscopic gastrostomy (PEG), which was performed for feeding purposes. It is postulated that the initial, unsuccessful attempt at needle puncture of the stomach, under endoscopic guidance, had resulted in iatrogenic perforation and laceration of the splenic and superior mesenteric veins close to their confluence with the portal vein. It would also appear that dense fibrous adhesions between the pyloro-antral region of the stomach and the posterior hepatic surface had altered the immediate anatomical relations of the stomach in such a manner as to have predisposed to these events.
Lau
G
G
Department of Forensic Medicine, Institute of Science and Forensic Medicine, Outram Road, Singapore 169608, Singapore.
Lai
S H
SH
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D016063:Blood Loss, Surgical; D003680:Deglutition Disorders / Q000150:complications / Q000628:therapy; D003704:Dementia / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D005554:Forensic Medicine; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006465:Hemoperitoneum / Q000150:complications / Q000209:etiology*; D006801:Humans; D008642:Mesenteric Veins / Q000293:injuries; D011014:Pneumonia / Q000150:complications; D012307:Risk Factors; D013162:Splenic Vein / Q000293:injuries; D013270:Stomach / Q000098:blood supply / Q000293:injuries