title: Peritonitis secondary to the migration of a trans-hepatically-placed percutaneous endoscopic gastrostomy tube: a case report.
abstract: Enteral feeding by percutaneous endoscopic gastrostomy (PEG) tube has become a commonly used method of supplying nutrition to patients with impaired neurologic function. In this case study we describe a 33-year-old brain-injured patient whose PEG insertion was complicated by inadvertent malpositioning and subsequent infection. After initially being placed through the liver, the PEG tube migrated out several weeks later, resulting in intra-abdominal feed collection, peri-hepatic abscess formation, and peritonitis. Physicians should be aware of the potential for inadvertent positioning through other viscera, and consider optimal methods of intraprocedural monitoring and post placement verification.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA. dburke2@emory.edu
authors.forename: David T
authors.initials: DT
authors.lastname: Burke
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Geller
mesh_terms: D000328:Adult; D017128:Embolectomy; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005548:Foreign-Body Migration; D005774:Gastrostomy / Q000295:instrumentation; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy; D008099:Liver; D008297:Male; D010538:Peritonitis / Q000209:etiology*