Joung Juyung, Baek Jeeyeon, Kang Sun Hyung, Moon Hee Seok, Sung Jae Kyu, Yun Hwan Jung
Korean J Helicobacter Up Gastrointest Res. 2024 Mar;24(1):72-76. doi: 10.7704/kjhugr.2023.0060. Epub 2024 Mar 8.
An 82-year-old man diagnosed with supraglottic cancer sought a consultation for percutaneous endoscopic gastrostomy (PEG) placement. Preoperative chest radiography (posterior-anterior [PA] view) revealed no abnormalities, and PEG tube placement was performed using the "pull" method. Chest radiography (PA view) performed 3 days postoperatively showed free air that was not observed immediately after PEG tube placement; therefore, the patient was diagnosed with pneumoperitoneum. Abdominal computed tomography confirmed that the PEG tube was appropriately positioned within the stomach; however, the colon was observed between the abdominal wall and stomach, which indicated that the PEG tube had passed through the colon. Review of preoperative chest radiographs (PA views) confirmed that the colon was visualized in the area wherein usually stomach gas should have been observed. The patient was diagnosed with a gastro-colo-cutaneous fistula that occurred postoperatively, following a procedure that was performed without confirmation of anatomical variations. The PEG tube was removed surgically, and we performed percutaneous gastrostomy.
一名82岁的声门上癌男性患者寻求经皮内镜下胃造口术(PEG)置管咨询。术前胸部X线摄影(后前位[PA]片)未发现异常,采用“牵拉”法进行PEG管置入。术后3天进行的胸部X线摄影(PA片)显示有游离气体,而PEG管置入后立即未观察到;因此,患者被诊断为气腹。腹部计算机断层扫描证实PEG管在胃内位置合适;然而,在腹壁和胃之间观察到结肠,这表明PEG管穿过了结肠。回顾术前胸部X线片(PA片)证实,在通常应观察到胃内气体的区域可见结肠。患者被诊断为术后发生的胃-结肠-皮肤瘘,这是在未确认解剖变异的情况下进行手术操作后发生的。手术取出PEG管,我们进行了经皮胃造口术。