G-tube complications

Background

Child with percutaneous gastrostomy tube (G-tube).

• Percutaneous gastrostomy tubes (PEG/G-tubes) are common in patients with impaired swallowing, neurologic disease, or need for chronic enteral access
• G-tube complications are a frequent ED presentation, especially in pediatric and geriatric patients
• Key EM pearl: a dislodged G-tube in a mature tract (>4-6 weeks old) must be replaced promptly — the tract can close within hours

Complications

G-tube complications

• Clogged G-tube
• Displaced G-tube
• Infected G-tube
• Leaking G-tube

Dislodged/Displaced Tube

• Most common ED presentation
• Mature tract (>4-6 weeks): replace with same-size tube or Foley catheter as bridge to prevent tract closure
  • Lubricate and gently advance; confirm placement with aspiration of gastric contents or water-soluble contrast study
  • Do NOT use air insufflation — risk of misplacement
• Immature tract (<4 weeks): higher risk of peritoneal misplacement → GI/surgery consultation; do NOT blindly replace
• Verify intragastric position: aspirate gastric contents (pH <4), instill water-soluble contrast and obtain abdominal X-ray

Clogged Tube

• Try warm water flush with 30-60 mL syringe (gentle pressure)
• Carbonated water, pancreatic enzyme solution, or meat tenderizer can help
• Avoid using wire/stylet to unclog (perforation risk)
• May need tube replacement if unable to clear

Peristomal Infection

• Erythema, warmth, purulent drainage at stoma site
• Mild: topical wound care, oral antibiotics (amoxicillin-clavulanate or cephalexin)
• Severe/cellulitis: IV antibiotics, assess for abscess (may need CT)
• Consider fungal infection (candida) — treat with topical antifungal

Buried Bumper Syndrome

• Internal bumper migrates into gastric/abdominal wall
• Presents with increasing resistance to feeds, pain, leaking
• Requires endoscopic or surgical removal — consult GI/surgery

Leaking Around Tube

• Common — often due to tube being too small, excessive traction, or granulation tissue
• Reduce traction, ensure proper tube size
• Silver nitrate for granulation tissue (if trained)

Peritonitis

• Rare but serious — tube tip in peritoneal cavity
• Fever, diffuse abdominal pain, peritoneal signs
• CT abdomen, IV antibiotics, surgical consultation

Evaluation

• Abdominal exam: peritoneal signs, peristomal skin assessment
• Confirm tube position if replaced: aspirate for gastric contents, water-soluble contrast study (do NOT use barium — peritonitis risk if extravasation)
• Abdominal X-ray or CT if concern for misplacement or peritonitis

Management Summary

• Dislodged + mature tract → replace, verify position, discharge with follow-up
• Dislodged + immature tract → consult GI/surgery, do not blindly replace
• Clogged → flush; replace if unable to clear
• Infection → antibiotics (PO or IV based on severity)
• Peritonitis → IV antibiotics, surgery consultation, admit

Disposition

• Discharge: successful tube replacement confirmed in position, mild peristomal infection, clogged tube resolved
• Admit: peritonitis, failed replacement, immature tract dislodgement, systemic infection

See Also

• Ostomy complications