Angiò L G, Versaci A, Rivoli G, Fracassi M G, Rosato A, Pacilè V, Famulari C
Cattedra di Chirurgia d'Urgenza, Dipartimento di Patologia Umana, Università degli Studi di Messina.
Ann Ital Chir. 2003 Mar-Apr;74(2):195-201.
PEG is more and more used for those patients who need a medium and above all long term enteral nutrition, especially at home. This is the closest technical system to the requirements to have an ideal nutritional access; however it is burdened, on average in 32.5% of cases, with complications linked to technical mistakes of positioning or to a wrong management, such as haemorrhage and gastric perforation.
A patient, subjected to supraglottic laryngectomy, to removal of tongue's base and to bilateral laterocervical lymphadenectomy and PEG carrier for 4 months, has arrived to our observation for a clinical outline of acute abdomen for perforation of hollow internal organ, preceded by progressive anaemia due to high digestive haemorrhage. Performed an exploratory laparotomy, it was discovered on the gastric fore face, between body and antrum, in proximity to the small curvature and in front of the PEG gastric access, a perforation with max 2 cm of diameter, crossed by probe's internal disk of retention. They proceeded to remove that, to unstick the gastric stoma from the parietal peritoneum, to suture the access of gastrostomy and the perforation by omentoplasty. Finally they carried out a jejunostomy for enteral feeding.
We think we can pathogenetically identify the cause of the haemorrhage and of the stomach's perforation, occurred in a short time in the case we have examined, in the probe's movement for incorrect fixing of the plate of external anchorage or for excessive slimming of the patient due to not balanced nutritional supply, as well as in the consequent extension of its intraluminal part with continuous rubbing by internal disk on the gastric wall and with onset decubitus ulcer. Physiopathologic moments, connected with the supposed etiological factor, make both occurred complications as an unique pathologic entity, which has to be observed in the PEG carriers, in order to be able to diagnose it and treat it precociously and above all in order to be able to prevent it. Only a correct technique of positioning and of nursing and of management of nutritional supply is able not to thwart the finality of the PEG device which can be considered, in the elective indications and for the favourable requisites that marks it, a valid access to enteral nutrition realization.
经皮内镜下胃造口术（PEG）越来越多地应用于那些需要中等及长期肠内营养的患者，尤其是在家中使用。这是最接近理想营养通路要求的技术系统；然而，平均有32.5%的病例会出现与置管技术失误或管理不当相关的并发症，如出血和胃穿孔。
一名患者接受了声门上喉切除术、舌根切除术和双侧颈侧淋巴结清扫术，并使用PEG导管4个月，因中空内脏器官穿孔导致急性腹痛的临床表现前来我院就诊，在此之前因严重消化道出血出现进行性贫血。进行了剖腹探查术，发现在胃前壁，胃体与胃窦之间，靠近小弯侧且在PEG胃造口处前方，有一个直径最大为2厘米的穿孔，留置探针的内盘穿过该穿孔。他们将其取出，将胃造口与腹膜壁层分离，通过网膜成形术缝合胃造口和穿孔。最后进行了空肠造口术用于肠内喂养。
我们认为，在我们所研究的病例中，短时间内发生出血和胃穿孔的病因，可能是由于外部固定板固定不当导致探针移动，或者由于营养供应不均衡导致患者过度消瘦，以及随之而来的探针腔内部分延长，其内部圆盘持续摩擦胃壁并引发褥疮性溃疡。与推测的病因相关的病理生理过程，使这两种并发症成为一个独特的病理实体，在PEG导管使用者中必须予以关注，以便能够早期诊断和治疗，最重要的是能够预防。只有正确的置管、护理和营养供应管理技术，才能不违背PEG装置的目的，在选择性适应症和有利条件下，PEG装置可被视为实现肠内营养的有效通路。
