title: Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) is a procedure used most commonly for enteral access for nutrition and continuation of treatment in patients when oral nutrition is not possible. It is a safe, cost-effective procedure; however, has its own complications and adverse effects that can be life threatening.
  
  
  METHODS
  Here, we present the case of a 76-year-old woman who was sent to a long-term skilled nursing facility after discharge from a hospital a month before, initially admitted for seizures after a fall and diabetic ketoacidosis. She underwent tracheostomy for prolonged respiratory support on mechanical ventilation and also underwent PEG tube placement. She presented in our Emergency Department (ED) with septic shock and multi-organ failure initially attributed to urinary tract infection and possible Clostridium difficile colitis. However, on further evaluation she was found to have a dislodged PEG tube, which led to development of gastro-hepatic fistula and multiple liver abscesses with liver necrosis. Comfort measures were implemented and she died due to her critical condition.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first case of a PEG tube, with no post-procedure complications, that dislodged and resulted in formation of a gastro-hepatic fistula and multiple liver abscesses. It is the first case that describes liver injury resulting from dislodgement rather than the liver being injured during the procedure of PEG tube placement itself.
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Arsalan
authors.initials: A
authors.lastname: Rafiq
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Naeem
authors.initials: N
authors.lastname: Abbas
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Tariq
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.
authors.forename: Suresh Kumar
authors.initials: SK
authors.lastname: Nayudu
mesh_terms: D000368:Aged; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography