Displaced G-tube
Displaced Gastrostomy 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
- Displacement is estimated to occur in 1.6-20% of patients with PEG tubes
Anatomy
The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall
Clinical Features
- G-tube fully removed or partially removed with deflated balloon exposed
Differential Diagnosis
G-tube complications
Diagnosis
- Clinical diagnosis
Management
Within 2-4 Weeks of Insertion
- Do not attempt to replace the tube
- This many not represent sufficient time for full epithelialization of the percutaneous tract
- Urgent general surgical, gastroenterology, or radiology consult is recommended
More Than 2-4 Weeks
- Reinsertion should be attempted as soon as possible
- Mature stomas close rapidly (within minutes to hours)
- Replacement tubes should be of the same size as the initial tube
- If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used
Replacing a G-Tube
- Deflate the balloon
- Lubricate the tube with lidocaine jelly
- Reinsert the tube along the tract. Never force the tube. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.
- Inflate the ballon with NS
- Apply gentle traction to position the balloon against the gastric wall
- Confirm positioning. Options include:
- Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.
- Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach.
- Check tube fluid: gastric fluid pH is normally <4.
Disposition
- Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult
- Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily