Intestinal obstruction after PEG tube replacement: implications to daily clinical practice.

One method commonly employed to remove percutaneous endoscopic gastrostomy (PEG) tubes is to disconnect the internal flange from the rest of the tube at skin level. The internal segment is then allowed to pass spontaneously through the gastrointestinal tract. This report describes a case in which the internal flange resulted in intestinal obstruction in a patient with underlying Crohn disease, necessitating surgical removal. The limited published literature relating to risks of retained PEG flanges is reviewed. This suggests that in patients with underlying gastrointestinal disease and other risk groups, disconnected internal PEG flanges should be retrieved endoscopically in preference to allow spontaneous passage.