Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Case Report

Volume 11, Number 2, April 2018, pages 145-149

Trans-Hepatic Percutaneous Endoscopic Gastrostomy Tube Placement: A Case Report of A Rare Complication and Literature Review


Figure 1.
Figure 1. Fluoroscopic evaluation of the abdomen demonstrated an air distended colonic loop anterior to the stomach. Accompanying schematic
Figure 2.
Figure 2. Axial CT (a) showing the percutaneous gastrostomy tube traversing the lateral margin of the liver with adjacent small hematoma (arrow). Accompanying sagittal view (b) and schematics.


Table 1. Significant Aspects of the Previously Reported Cases
AuthorAge/sexIndicationPEG techniquePresentationDiagnosisTreatmentOutcome
Chaer et al (2003) [12]78 years/femaleOropharyngeal cancerTrans illumination (pull technique)2.5 months later with concerns for tube malfunctionContrast radiograph: PEG tube within liverLaparotomy: removal of PEG tube and placement of new tubeNo long term complication
Gubler et al (2005) [13]59 years/maleNasopharyngeal cancerTrans illumination1 week later with pain around PEG siteUltrasound: PEG tube along edge of left liver lobe10-day course of analgesics with pain resolutionAsymptomatic at 6 month follow up
Gubler et al (2005) [13]81 years/femaleEsophageal cancerTrans illumination1 week later with abdominal discomfortUltrasound: PEG tube along edge of left liver lobe3-week course of analgesics with pain resolutionDeath at 6 weeks from respiratory failure, unrelated to PEG
Wiggins et al (2007) [14]61 years/femaleProlonged ventilation requirementTrans illumination (pull technique)Abdominal pain and hypotension 8 h after procedureComputed Tomography: PEG tube in left hepatic lobe, 10.1 cm sub capsular hematomaLaparotomy: tube removal, repair of liver laceration and insertion of new tubeDeath at 3 months from respiratory failure, unrelated to PEG
Burke et al (2009) [15]33 years/maleIntracranial hemorrhageTrans illuminationFevers, chills and transaminitis after 7 weeks of placementComputed Tomography: PEG tube terminus outside stomach near liverAntibiotics, Laparotomy: tube removal and closure of gastro-hepatic fistula.Abscess development a week after laparotomy, drained under sonographic guidance. Long term outcome not mentioned
Herta et al (2015) [16]44 years/no mentionHypopharyngeal cancerTransillumination (pull technique)4 days later with abdominal painUltrasound: hepatomegaly, peri-hepatic ascites and PEG tube in left hepatic lobePEG removal, closure of gastric insertion site. New PEG tube inserted a week laterNo immediate complications. Long term outcome not mentioned