Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Nutrition. 2011 Sep;27(9):979-81. doi: 10.1016/j.nut.2010.12.018. Epub 2011 Apr 15.
Percutaneous endoscopic gastrostomy (PEG) is a common and safe procedure for enteral nutrition. There are few reports concerning its complications. We managed a 31-y-old bedridden case with punched out duodenal perforation without inflammation, from which the tip of the PEG tube protruded. Simple x-ray and computed tomography showed incarceration of the balloon in the duodenal bulb and extravasation of the tip of the tube. We performed simple closure with omental patching for duodenal perforation. Postoperative gastrointestinal fiberscopy on the 11th day revealed scar phase. Some PEG tubes have a balloon, which can prevent the removal of the tube, fix the position of the tube, and prevent the leakage of gastric contents from fistula. However, in our case, the inflated balloon was transferred into the duodenal bulb according to gastric strong peristalsis. This pathophysiologic mechanism is the same as ball bulb syndrome, which is known as gastroduodenal obstruction by incarceration of the gastric submucosal tumor. There is a risk of wedging of the inflated balloon of the PEG tube and perforation of the duodenum. We must not insert the tube too deeply, must not continue to inflate the balloon for a long time, and must check its position using a stethoscope, simple x-ray examination, or ultrasound.
经皮内镜胃造口术（PEG）是一种用于肠内营养的常见且安全的程序。关于其并发症的报道很少。我们治疗了一名 31 岁卧床不起的患者，其十二指肠穿孔呈打孔状且无炎症，PEG 管的尖端从穿孔处突出。简单的 X 光和计算机断层扫描显示球囊卡在十二指肠球部并使管尖端外渗。我们对十二指肠穿孔进行了简单的网膜补丁缝合。第 11 天行胃肠纤维镜检查显示瘢痕期。一些 PEG 管带有球囊，可防止管子被拔出、固定管子位置并防止瘘管处胃内容物泄漏。然而，在我们的病例中，充气球囊根据胃强烈蠕动转移到十二指肠球部。这种病理生理机制与球囊综合征相同，即胃黏膜下肿瘤嵌顿导致胃十二指肠梗阻。PEG 管充气球囊有嵌顿和十二指肠穿孔的风险。我们不能将管子插入太深，不能长时间充气，并且必须使用听诊器、简单的 X 光检查或超声检查来检查其位置。
