An Uncommon Complication of Percutaneous Endoscopic Gastrostomy Tube Placement

Abstract

Question: A 75-year-old nursing home resident was referred by her local medical officer with a 5-month history of an enlarging exophytic growth from around her percutaneous endoscopic gastrostomy (PEG) site. Her initial PEG was placed 7 years prior, when she suffered a large cerebral hemorrhage, with secondary oropharyngeal dysphagia. At the time, she was already suffering from early cognitive impairment, which had progressed over the subsequent years. The growth was noticed after a new feeding tube was replaced percutaneously, without endoscopic assistance, when the previous PEG was accidentally dislodged. In the months leading up to her assessment, there were observations from the patient’s family of altered behavior, including frequent gesturing at the PEG site, suggestive of some associated discomfort. Examination of the PEG site revealed a 3-cm, exophytic, fleshy mass that encircled the PEG tube (Figure A). No ulceration was evident. The origin of the lesion seemed to arise deep to the cutaneous layer. The PEG tube seemed to be freely mobile and was in good position. No evidence of organomegaly, ascites, or peritonism was identified on examination. A biopsy was performed of the lesion (Figure B). Computed tomography was performed (Figure C–E). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.