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

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

References