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Leaking G-tube
From WikEM
Contents
Background
- The percutaneous gastrostomy tube (PEG) is commonly indicated in:
- patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
- oropharyngeal or esophageal obstruction
- major facial trauma
- passive gastric decompression
- mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation.
- Most PEGs are 18F to 28F and may be used for 12-24mo
Clinical Features
- Drainage from the stoma is common
- Frequently due to a foreign body reaction to the tube
- Simple foreign body reactions should be differentiated from cellulitis and necrotizing fasciitis
Differential Diagnosis
G-tube Complications
- Clogged G-tube
- Displaced G-tube
- Infected G-tube
- Leaking G-tube
Evaluation
- Clinical diagnosis
Management
- Simple foreign body reactions can be managed with local skin care (cleaning with hydrogen peroxide and warm water)
- Leakage of gastric contents around the tube indicates that the percutaneous tract is too large for the tube; management should include the physician or service responsible for placing the tube, and may include:
- Removal for 24-48hrs (with the optional placement of a guidewire) to promote shrinking of the percutaneous tract
- Complete removal of the PEG with the intent of tract closure and subsequent placement of a new PEG at an alternate location
- Leakage of gastric fluid into the peritoneal cavity results in chemical and bacterial peritonitis; management may include:
- Discontinuing tube feeds
- Starting empiric antibiotics initiated
- Obtain imaging and surgical consult
Disposition
- Simple foreign body reaction: home with skin care teaching
- Other management in conjunction with consultant
See Also
- G-tube complications
- Clogged G-tube
- Displaced G-tube
- Infected G-tube
- Leaking G-tube
