Peacock Oliver, Singh Rajeev, Cole Andrew, Speake William
Department of General Surgery, Royal Derby Hospital, Derby, UK.
BMJ Case Rep. 2012 Jul 27;2012:bcr2012006607. doi: 10.1136/bcr-2012-006607.
Percutaneous endoscopic gastrostomy (PEG) feeding is routinely used as an endoscopic and effective method for providing enteral nutrition in those whose oral access has been diminished or lost. One technique for removal of the PEG is cutting the tube at the skin level and allowing the tube and internal flange to pass spontaneously. This is known as the 'cut and push' method. Several studies have concluded that the 'cut and push' method is a safe and cost-effective method. This case demonstrates a rare cause of small bowel obstruction following the 'cut and push' method for PEG replacement, with only a few other cases been reported. This method of removal should be avoided in patients with previous abdominal surgery. It is important that the PEG flange is retrieved endoscopically or an alternative PEG tube (designed to be completely removed through the skin) is used to prevent this complication occurring in such individuals.
经皮内镜下胃造口术（PEG）喂养通常作为一种内镜下有效的方法，用于为口腔摄入减少或丧失的患者提供肠内营养。PEG移除的一种技术是在皮肤水平切断管子，让管子和内部凸缘自行排出。这被称为“切断并推挤”法。多项研究得出结论，“切断并推挤”法是一种安全且具有成本效益的方法。本病例展示了采用“切断并推挤”法更换PEG后导致小肠梗阻的罕见原因，仅有其他少数病例被报道。既往有腹部手术史的患者应避免使用这种移除方法。重要的是，应通过内镜取出PEG凸缘，或者使用可经皮肤完全取出的替代PEG管，以防止此类个体发生这种并发症。
