title: Migration in two directions.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG), the modality of choice for long-term enteral access, is generally a safe procedure but can be associated with many potential complications.
  
  
  OBJECTIVE
  Report two different and late complications of PEG in two patients fed at home, leading them to the emergency department.
  
  
  METHODS
  A 75-year-old man and a 14-year-old young man with PEG presented to the emergency department with two different complications related to the gastrostomy tube. The first patient developed fever and deterioration in mental status due to parietal abscess which developed secondary to the migration of the internal button of the gastrostomy tube in the abdominal wall. He was treated with antibiotics and the gastrostomy tube was extracted. The second one presented upper gastrointestinal bleeding due to intestinal perforation at the level of the internal button of the gastrostomy tube. Bleeding and perforation were treated conservatively and he had a good evolution.
  
  
  CONCLUSIONS
  Persons taking care of patients with PEG tube must be aware of potential complications. The position and the permeability of the tube must be systematically checked before feeding and medical advice should immediately be asked for in case of doubt or in the presence of any alarming sign.
authors.affiliation: Department of Gastroenterology, Hôtel-Dieu de France University Hospital, Achrafieh, Beirut, Lebanon. rslimkaram@hotmail.com
authors.forename: Rita
authors.initials: R
authors.lastname: Slim
authors.forename: Salam
authors.initials: S
authors.lastname: Koussa
authors.forename: Hassan
authors.initials: H
authors.lastname: Awada
authors.forename: Cesar
authors.initials: C
authors.lastname: Yaghi
authors.forename: Khalil
authors.initials: K
authors.lastname: Honein
authors.forename: Raymond
authors.initials: R
authors.lastname: Sayegh
mesh_terms: D000293:Adolescent; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D005334:Fever / Q000209:etiology; D005548:Foreign-Body Migration / Q000150:complications* / Q000209:etiology / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology* / Q000601:surgery; D008297:Male