Early dislodgement of percutaneous and endoscopic gastrostomy tube.

One of the most serious complications of PEG tube placement is the inadvertent removal of the gastrostomy tube. This case report describes an elderly patient with a severe mental disorder who inadvertently pulled her PEG tube only hours after insertion and the subsequent therapeutic maneuvers to save it. If this occurs within 14 days of insertion, a mature tract has not adequately developed and blind reinsertion should not be attemped. In review of the literature, endoscopic replacement is preferred over celiotomy in the absence of peritonitis and this can be attempted early after dislodgement. Septic complications are not increased and gastric leakage does not appear to be clinically significant in patients with premature dislodgement of the gastrostomy tube. Alternatively, careful observation can also be recommended for several days in the absence of peritonitis and reinsertion may occur endoscopically 5 to 7 days later. If peritonitis develops, then laparoscopic exploration is recommended. Dislodgment of the tube by the patient can be prevented by appropriate patient selection, and securing and protecting the tube after placement. Patients with a history of pulling tubes and intravenous lines should undergo PEG placement using T-fastners.