Fatal complication of peg tube insertiona case report

PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. PEG is currently the method of choice for medium-and long-term enteral feeding. PEG tube insertion is usually considered a safe procedure, however, complications can occur with a variable rate based on the study population. These complications can be classified as minor or major. Minor complications include wound infection, tube leakage to abdominal cavity (peritonitis), stoma leakage, inadvertent PEG removal, tube blockage, pneumoperitoneum, gastric outlet obstruction and peritonitis. While major complications are aspiration pneumonia, haemorrhage, buried bumper syndrome, perforation of bowel, necrotizing fasciitis and metastatic seeding. Bleeding from the PEG tract, gastric artery, splenic or mesenteric vein injuries (massive retroperitoneal bleeding) and rectus sheath hematoma have been reported.The incidence of majorcomplications after PEG has been found to range from 0 to 6%. Hereby, we present a case of a 63 year old male met with road traffic accident and sustained cervical spine injury. He was admitted in a private hospital where he was operated for cervical spine injury and cervical vertebra fracture which was at C3 to C5 level, was fixed with metallic plate and screws. He stayed in hospital for about 2 months and was apparently alright. When he was about to discharge the doctors planned to place a percutaneous endoscopic gastrostomy (PEG) tube. During the PEG tube insertion procedure the doctor accidentally damaged the part of stomach which was rich in vascular supply. Following the procedure the patient went in shock. The doctors could not find the reason for it and patient died in few hours. The injury over the stomach was diagnosed during the autopsy which suggested negligence on the part of the doctor who did the PEG tube insertion procedure. The patient died due to haemorrhagic shock consequent upon described vascular injury to the stomach.