[Rare cause of recurrent subileus].

HISTORY AND CLINICAL FINDINGS: An 85-years-old woman with percutaneous endoscopic gastrostomy (PEG) presented at our emergency unit with repeating abdominal pain and changes in the consistency of the stool. The PEG was placed during a treatment of an oropharynxcarcinoma in the past, was replaced repeatedly and is still in use.

INVESTIGATIONS: The initial clinical results were unobtrusive; the ultrasound of the abdomen showed mild distended loops of the small intestine, the x-ray of the abdomen was unsuspicious with diagnosis of subileus by constipation. The esophagogastroduodenoscopy was also without pathological findings and showed correct position of the PEG and normal aspect of the gastric tissue. An additional computerized tomography (ct-scan) of the abdomen demonstrated a foreign body nearly 2.5 cm in diameter in the distal part of the small intestine, the terminal ileum, differentiated as PEG retaining plate, also seen retrospectively in the initial x-ray.

TREATMENT AND COURSE: Because the endoscopic salvage failed, the foreign body had to be removed surgically. The retaining plate was the cause for subtotal occlusion and also for the perforation of the small intestine. It was found nearly 15 cm before ileo-terminal valve. After operation the patient recovered soon.

CONCLUSION

The history gave no hints of accidentally broken PEG-tube; presumably the retaining plate was cut off while the PEG was changed and let go on natural way. The aim of gastroenterologists should be removing PEG under endoscopic control.