INTRODUCTION: ICU admission for acute abdomen secondary to PEG tube related complications are not common. We present a clinical condition where the entire PEG tube was internally displaced and cause intestinal obstruction.
CASE PRESENTATION: This is an 85 year old, obese, demented female patient who presented to us with abdominal distension and pain with constipation. She had a PEG tube placed four years ago for the dysphagia during the recovery phase of neck surgery. Six months later she had signifcant improvment and started to take the food orally with no difficulty. While continuing to eat by mouth, she did not visit her physician regularly for proper care of the PEG tube. An year later, the external flange which hold the PEG tube fell off and subsequently the PEG tube too disappeared. The patient and her family perceived that the tube had fallen off. The PEG site wound was left for natural healing with occasional dressing. She continued her routine without much difficulty, eating by mouth until 3 days prior to this admission, when she developed constipation, abdominal pain and distension. She was found to be in moderate pain with distended and tender abdomen with hyperactive bowels and foul smelling discharging wound at the original PEG site. CT abdomen revealed the entire PEG tube was found in the ileum causing complete small bowell obstruction. During the explorative laporotomy the PEG tube was seen obstructing the distal ileum with proximal dilatation of bowel without any ruptured viscus or evidence of peritonitis. The PEG tube was removed and the surgery was uneventful. Patient went home with no further complication.
DISCUSSIONS: Placement of PEG tube has been a common practise in geriatric population who have deranged swallowing mechanism for variety of reasons. The procedure has been considered safe with minor complications. Tube blockage, infected tube insertion site, abscess, dislodgement, bleeding, breaking of tube have all been described as complications. However internal displacement of entire PEG tube is a rare but a serious complication could cause high morbidity and in some cases even mortality specially in elderly, demented patients.
CONCLUSION: Regular follow up is essential for the care of PEG tube along with assisted or supervised feeding in elderly, demented patients to prevent serious and potentially life threatening complications. These patients generally does not have adequate supportive care available at home. Institutionalization is another possible way to provide adequate supervision to prevent these complications.
DISCLOSURE: Subakeesan Pathmanathan, No Financial Disclosure Information; No Product/Research Disclosure Information