胃ろうチューブ交換時に生じた腹腔内誤挿入に対し外来処置のみで対処が可能であった１例

Abstract

We report a case of a 53-year-old man, who had been bed-ridden due to the progression of spinocerebellar degeneration and had been relying on percutaneous endoscopic gastrostomy (PEG) feeding for long-term nutritional support at home. The patient was referred to our clinic from his local GP because of suspected misinsertion of the PEG tube into the abdominal cavity on regular exchange of the tube. We performed emergent gastric endoscopy. First we induced the biopsy forceps through an endoscopic fiber, and pulled the forceps out through the injured fistula to the surface. Then the loop wire used for PEG placement was inserted through the fistula to the stomach using the forceps. The PEG tube was then inserted per oral and replacement was completed according to the usual pull-method. This procedure enabled the replaced PEG tube to cover the perforated site as well as to reduce intragastric pressure, thereby prevented the occurrence of panperitonitis, a common severe complication expected in case of perforated fistula, caused by the leakage of intragastric contents. The patient showed no signs of complications, and could continue to receive in-home care without being admitted to the hospital for acute care.