Two Cases Involving Gastric Ulceration and Bleeding from Recent Placement of Gastrostomy Tubes with T-Fasteners

Abstract

Purpose: The purpose of this case series is to elucidate an unforeseen complication related to (T-tacks) in the assistance of RIG and PIG. Results: Both cases involved a 68 and an 82 yr CVA patients with recent placement of Gastrostomy tubes. T-tacks were used in both cases for gastropexy to aid in the introduction of the gastrostomy tubes. In both cases the patients returned to the ER with upper Gi bleeding 1–2 weeks post-gastrostomy placement. Both patients were resuscitated in the emergency department. The 68 yr patient was endoscoped under conscious sedation. Endoscopic exam of the esophagus and duodenum was normal. The gastrostomy site was identified and the gastric bumper was noted to be in good position. Along side of the bumper were the retained T-tacks. One of the T-tacks was abutting into the gastric wall where an actively bleeding gastric ulcer was identified. The area was injected with epinephrine 1:10,000 mixture and bicaped with good hemostats is. The t-tacks were then removed with a snare on a second sitting. The patient went home but did return with continued bleeding from the previous ulcer site. The patient was re-treated with Epi and bicap and hemostasis was maintained. The 82 yr patient presented to the ER 3 weeks after the above patient with similar scenario. Endoscopy was performed that day and the gastrostomy site was identified. No erosions or ulcerations were identified in the antrum. Upon inspection of the gastrostomy site was the presence of two T-tacks with one buried into the gastric wall. There was surrounding edema and ulceration at the site. In this case the T-tacks were attached to the external bumper via suture material. The sutures were released from the bumper. Grasping forceps were then used to endoscopically remove the T-tacks from the gastric wall.[figure1][figure2]FigureFigure