Percutaneous endoscopic gastrostomy has become the procedure of choice for the establishment of enteral feedings in most clinical settings. Minor modifications in the technique and tools of PEG may have had some effect on the type of complications seen with this procedure. The major and minor complications of PEG are reviewed with a focus on those manipulations that may assist in reducing the incidence of common complications of this procedure.

Newer percutaneous endoscopy gastrostomy (PEG) tubes with soft internal bolsters may be prone to accidental dislodgement or removal by patients. When this occurs after a mature gastrocutaneous fistula has formed, it is of little consequence as long as a replacement tube is promptly reinserted before the track closes. Blind reinsertion of a replacement tube before the track is adequately mature may have serious consequences, as exemplified by a patient who developed peritonitis as a result of inadvertent insertion into the peritoneal cavity. We managed two other patients with early accidental PEG tube removal by a period of nasogastric (NG) suction, intravenous antibiotic drugs, and observation, with a new tube placed endoscopically 7-9 days later. We review the management of early, inadvertent dislodgement of PEG tubes.

BACKGROUND: To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children. METHODS: Patients developing peritonitis after PEG insertion during a 5-year period (1990-95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome. RESULTS: One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3-18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases. CONCLUSIONS: Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.