title: Use of a venting PEG tube in the management of recurrent acute gastric dilatation associated with Prader-Willi syndrome.
abstract: A patient with Prader-Willi Syndrome was admitted to the ICU with features of recurrent acute gastric dilatation, aspiration pneumonia and a massive pulmonary embolus. He was initially managed with intubation, assisted ventilation, intravenous fluids and anticoagulation. Decompression of the stomach was achieved with a nasogastric tube. After ventilator weaning, he did not tolerate the nasogastric intubation that led to a further episode of aspiration pneumonia as a result of non-resolving gastric dilatation. He required readmission to intensive care for a further period of ventilatory support. While the patient was sedated and ventilated, a venting percutaneous endoscopic gastrostomy (PEG) with a jejunal feeding extension was placed, permitting both continued decompression of the stomach and enteral feeding. The patient tolerated the PEG-J well and his nutritional needs were successfully addressed. Oral intake was slowly re-established with ongoing decompression of the stomach with the PEG. He was discharged from hospital with the PEG in place.
authors.affiliation: General Surgery, Kings Mill Hospital, Sutton in Ashfield, UK ahmed.mohammed@doctors.net.uk.
authors.forename: Ahmed M A
authors.initials: AM
authors.lastname: Mohammed
authors.affiliation: Peterborough City Hospital, Peterborough, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dennis