Clin Endosc.  2015 Jan;48(1):78-80. 10.5946/ce.2015.48.1.78.

Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy

• Kotzampassi K
• Stavrou G

• KMID: 2221764
• DOI: http://doi.org/10.5946/ce.2015.48.1.78

Abstract

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.

Keyword

Percutaneous endoscopic gastrostomy; Head and neck malignancy; Surgical gastrostomy; Peristomal leakage; Gastric fistula

MeSH Terms

Abdominal Wall
Endoscopes
Fasciitis, Necrotizing
Female
Gastric Fistula
Gastrostomy*
Humans
Inflammation
Mouth
Skin
Stomach

Figure

• 

  Fig. 1 Extracorporeal view of the two stomas being in a distance of 10 cm away. The new gastrostomy tube, already attached to the thread, is pulled through the new puncture site.

• 

  Fig. 2 Endoscopic view of the two stomas being in the gastric antrum. After termination of the procedure, the gastroscope re-inserted through the old stoma for inspection and photography; the internal dome of the new gastrostomy is seen protruded through the new stoma. In the left part gastric fundus and angle are prominent.

Reference

1. Burkitt P, Carter LM, Smith AB, Kanatas A. Outcomes of percutaneous endoscopic gastrostomy and radiologically inserted gastrostomy in patients with head and neck cancer: a systematic review. Br J Oral Maxillofac Surg. 2011; 49:516–520. PMID: 20952109.

2. Schrag SP, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007; 16:407–418. PMID: 18193123.

3. Ono H, Ito S, Yamazaki Y, Otaki Y, Otaki H. Effects of gastric acidity on peristomal infection after percutaneous endoscopic gastrostomy placement. J Hosp Infect. 2010; 76:42–45. PMID: 20580127.

4. Rey JR, Axon A, Budzynska A, Kruse A, Nowak A. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy. 1998; 30:318–324. PMID: 9615888.

5. McAllister P, MacIver C, Wales C, et al. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg. 2013; 51:714–718. PMID: 23954134.