CONSERVATIVE TREATMENT OF ACUTE OMENTAL HEMATOMA AFTER PEG WITH T-FASTENER TECHNIQUE: A CASE REPORT

Abstract

PEG is an endoscopic operative procedure used for feed and nutritional support. We report a case of conservative treatment of a big omental hematoma due to PEG placement with T-fastener technique. A 69-years old man with SLA was admitted to our Institute to undergo PEG placement with T-fastener technique. Following the procedure, after some hours, appeared moderate anemia, hypotension, tachycardia and lower abdominal pain. There was no blood from the PEG tube but gastric secretion. There were no signs of peritonitis. Due of the worsening of anemia and pain a CT scan was performed in the evening with evidence of coarse acute hematoma of the greater omentum with venous bleeding of gastrocolic ligament. The PEG tube was in the correct position. The hemodynamic stability permitted not to proceed with immediate surgical treatment but conservative mode. Erythrocyte suspention was transfused. A new CT scan was performed after six days with evidence of reduction in hematoma volume. The patient was discharged in 11th post-procedural days. Introducer T-fastener technique is a it is a safe, effective technique, widely used in patients in serious general clinical conditions. In this case the complication was probably due to use of gastropexis technique with T-fastener nylon wires before trans-abdominal introduction of PEG tube. Post-operative bleeding is not frequent but serious complication after PEG procedure. Intraperitoneal hematoma is rare and difficult to diagnose because of lack of intragastric bleeding. This tecnique, associated with gastropexy with nylon threads (T-fastener gastropexis), however, it remains a safe, rapid and selected technique.