Imamura Hiroshi, Konagaya Toshihiro, Hashimoto Takashi, Kasugai Kunio
Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, 21, Karimata, Yazako, Aichi-Gun, Aichi-Ken, Japan.
World J Gastroenterol. 2007 Oct 21;13(39):5285-7. doi: 10.3748/wjg.v13.i39.5285.
Percutaneous endoscopic gastrostomy (PEG) is generally considered safe with a low rate of serious complications. However, dislocation of the PEG-tube into the duodenum can lead to serious complications. An 86-year old Japanese woman with PEG-tube feeding sometimes vomited after her family doctor replaced the PEG-tube without radiologic confirmation. At her hospitalization, she complained of severe tenderness at the epigastric region and the PEG-tube was drawn into the stomach. Imaging studies showed that the tip of PEG-tube with the inflated balloon was migrated into the second portion of the duodenum, suggesting that it might have obstructed the bile and pancreatic ducts, inducing cholangitis and pancreatitis. After the PEG-tube was replaced at the appropriate position, vomiting and abdominal tenderness improved dramatically and laboratory studies became normal immediately. Our case suggests that it is important to secure PEG-tube at the level of skin, especially after replacement.
经皮内镜下胃造口术（PEG）通常被认为是安全的，严重并发症发生率较低。然而，PEG管移位至十二指肠可导致严重并发症。一名86岁的日本女性通过PEG管进行喂养，在其家庭医生未进行放射学确认就更换PEG管后，她有时会呕吐。住院时，她主诉上腹部有严重压痛，且PEG管被拉入胃内。影像学检查显示，带有充气气囊的PEG管尖端已迁移至十二指肠第二部，提示可能阻塞了胆管和胰管，引发了胆管炎和胰腺炎。在将PEG管更换至合适位置后，呕吐和腹部压痛明显改善，实验室检查结果也立即恢复正常。我们的病例表明，在皮肤水平固定PEG管很重要，尤其是在更换后。
