Leaking G-tube

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