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 03 July 2022

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Enteral nutrition

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Complication of PEG feeding tube
A 31-year-old woman with generalized dystonia, who developed dysphagia and required oral supplementation via a (percutaneous endoscopically inserted) gastrostomy. With her dystonic movements, she had several tube displacements and the PEG had to be replaced on four occasions. On the fourth occasion the balloon ruptured as the catheter was being removed. She was then able to managed without tube supplements. However, in the two months subsequent to the tube removal she had persistant discharge of gastric contents from the PEG site. A probe could be inserted throughout the length of the fistula tract. The endoscopic photograph shows the site of the fistula - which has been outlined by methylene blue injected at the skin surface. As no foreign material could be seen endoscopically, the fistula tract was explored and excised. The opened specimen shows the thickened, fibrotic tract and remnants of balloon (coated in methylene blue). The arrow points to the gastric end of the fistula.

Comment: On removal of a tube gastrostomy or tube jejunostomy, the tube tract will invariably close over within a few hours. Failure to close should make the clinician think, and remember the old surgical principle: persistance of a fistula implies underlying disease - in this case, a foreign body.


Peter Devitt, Adelaide, Australia

Complication of PEG feeding tube

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