Korean J Gastroenterol.  2018 Dec;72(6):308-312. 10.4166/kjg.2018.72.6.308.

Percutaneous Endoscopic Gastrostomy Tube Insertion-induced Superior Mesenteric Artery Injury Treated with Angiography

• Lee SH
• Moon HS
• Park JH
• Kim JS
• Kang SH
• Lee ES
• Kim SH
• Sung JK
• Lee BS
• Jeong HY

• KMID: 2429948
• DOI: http://doi.org/10.4166/kjg.2018.72.6.308

Abstract

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.

Keyword

Gastrostomy; Endoscopy; Hemorrhage; Angiography

MeSH Terms

Anesthesia, Local
Angiography*
Anti-Bacterial Agents
Consciousness
Deglutition Disorders
Eating
Endoscopy
Gastrostomy*
Hemoperitoneum
Hemorrhage
Humans
Hypotension
Mesenteric Artery, Superior*
Middle Aged
Needles
Nutritional Support
Pancreatitis
Pneumonia
Punctures
Tracheostomy
Anti-Bacterial Agents

Figure

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  Fig. 1 The percutaneous endoscopic gastrostomy tube was inserted successfully.

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  Fig. 2 (A) Abdominal CT showed contrast media leakage from a pancreatic branch of the SMA suggestive of bleeding, and (B) moderate amounts of fluid collection with high attenuation in perihepatic and perisplenic spaces and pelvic cavity suggesting hemoperitoneum. CT, computed tomography; SMA, superior mesenteric artery.

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  Fig. 3 Gelform embolization was performed with a microcatheter.

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  Fig. 4 Abdominal CT obtained one week after embolization showed no further bleeding but demonstrated the presence of acute pancreatitis and peripancreatic fluid collection. CT, computed tomography.

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  Fig. 5 Abdominal CT obtained 3 months after embolization showed reduced peripancreatic fluid collection and improved pancreatitis. CT, computed tomography.

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