Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

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. Fluoroscopic evaluation of the abdomen demonstrated an air distended colonic loop anterior to the stomach. Accompanying schematic

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
Author	Age/sex	Indication	PEG technique	Presentation	Diagnosis	Treatment	Outcome
Chaer et al (2003) [12]	78 years/female	Oropharyngeal cancer	Trans illumination (pull technique)	2.5 months later with concerns for tube malfunction	Contrast radiograph: PEG tube within liver	Laparotomy: removal of PEG tube and placement of new tube	No long term complication
Gubler et al (2005) [13]	59 years/male	Nasopharyngeal cancer	Trans illumination	1 week later with pain around PEG site	Ultrasound: PEG tube along edge of left liver lobe	10-day course of analgesics with pain resolution	Asymptomatic at 6 month follow up
Gubler et al (2005) [13]	81 years/female	Esophageal cancer	Trans illumination	1 week later with abdominal discomfort	Ultrasound: PEG tube along edge of left liver lobe	3-week course of analgesics with pain resolution	Death at 6 weeks from respiratory failure, unrelated to PEG
Wiggins et al (2007) [14]	61 years/female	Prolonged ventilation requirement	Trans illumination (pull technique)	Abdominal pain and hypotension 8 h after procedure	Computed Tomography: PEG tube in left hepatic lobe, 10.1 cm sub capsular hematoma	Laparotomy: tube removal, repair of liver laceration and insertion of new tube	Death at 3 months from respiratory failure, unrelated to PEG
Burke et al (2009) [15]	33 years/male	Intracranial hemorrhage	Trans illumination	Fevers, chills and transaminitis after 7 weeks of placement	Computed Tomography: PEG tube terminus outside stomach near liver	Antibiotics, 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 mention	Hypopharyngeal cancer	Transillumination (pull technique)	4 days later with abdominal pain	Ultrasound: hepatomegaly, peri-hepatic ascites and PEG tube in left hepatic lobe	PEG removal, closure of gastric insertion site. New PEG tube inserted a week later	No immediate complications. Long term outcome not mentioned

Table 1. Significant Aspects of the Previously Reported Cases

Author

Age/sex

Indication

PEG technique

Presentation

Diagnosis

Treatment

Outcome

Chaer et al (2003) [12]

78 years/female

Oropharyngeal cancer

Trans illumination (pull technique)

2.5 months later with concerns for tube malfunction

Contrast radiograph: PEG tube within liver

Laparotomy: removal of PEG tube and placement of new tube

No long term complication

Gubler et al (2005) [13]

59 years/male

Nasopharyngeal cancer

Trans illumination

1 week later with pain around PEG site

Ultrasound: PEG tube along edge of left liver lobe

10-day course of analgesics with pain resolution

Asymptomatic at 6 month follow up

Gubler et al (2005) [13]

81 years/female

Esophageal cancer

Trans illumination

1 week later with abdominal discomfort

Ultrasound: PEG tube along edge of left liver lobe

3-week course of analgesics with pain resolution

Death at 6 weeks from respiratory failure, unrelated to PEG

Wiggins et al (2007) [14]

61 years/female

Prolonged ventilation requirement

Trans illumination (pull technique)

Abdominal pain and hypotension 8 h after procedure

Computed Tomography: PEG tube in left hepatic lobe, 10.1 cm sub capsular hematoma

Laparotomy: tube removal, repair of liver laceration and insertion of new tube

Death at 3 months from respiratory failure, unrelated to PEG

Burke et al (2009) [15]

33 years/male

Intracranial hemorrhage

Trans illumination

Fevers, chills and transaminitis after 7 weeks of placement

Computed Tomography: PEG tube terminus outside stomach near liver

Antibiotics, 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 mention

Hypopharyngeal cancer

Transillumination (pull technique)

4 days later with abdominal pain

Ultrasound: hepatomegaly, peri-hepatic ascites and PEG tube in left hepatic lobe

PEG removal, closure of gastric insertion site. New PEG tube inserted a week later

No immediate complications. Long term outcome not mentioned