Accidental transhepatic percutaneous endoscopic gastrostomy tube placement with subtotal gastrectomy

Abstract

An 81-year-old woman with a medical history of cerebral infarction and recurrent aspiration pneumonia was referred to our department for insertion of a PEG tube. In addition, she had undergone subtotal gastrectomy with Billroth II anastomosis for treatment of gastric cancer. PEG tube placement was carried out in the interventional radiology room with a fluoroscopic evaluation. A PEG tube was located at the lesser curvature side of the midbody (A). The patient tolerated the procedure with no immediate adverse event. After the procedure, no free air was seen on chest and abdominal radiographs. Three days after the procedure, the inflammation markers were significantly higher than expected, so we checked the CT of the abdomen. Imaging showed a transhepatic placement of the PEG tube and a small perihepatic fluid collection with mild biliary duct dilatation (B, C). Broad-spectrum antibiotics were used, with close observation. Eleven days after the PEG tube insertion, we removed the PEG tube with an endoscopic snare at the direction of the oral side. We used histoacryl to close the gastrohepatic fistula (D). After the procedure, the patient showed no procedure-related adverse events. As far as we know, this is the first reported case of transhepatic PEG tube placement in the setting of subtotal gastrectomy.