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Unusual Tract and Complication of a Percutaneous Gastrostomy Tube

Adorisio, Ottavio*; de Ville de Goyet, Jean

Journal of Pediatric Gastroenterology and Nutrition: March 2017 - Volume 64 - Issue 3 - p e71
doi: 10.1097/MPG.0000000000000779
Image of the Month

*Pediatric Surgery Unit, Passoscuro

Hepato-Biliary Surgery Unit, Department of Pediatric Surgery and Transplantation Center, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.

Address correspondence and reprint requests to Ottavio Adorisio, Department of Pediatric Surgery, Children's Hospital “Bambino Gesù Children's Hospital, via della torre di Palidoro 50, Palidoro, Rome, Italy (e-mail:

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A combined kidney-liver transplantation was performed in a 9-year-old boy with a condition of hyperoxaluria type 1. Two years before, he had undergone a percutaneous endoscopic gastrostomy (as per guidelines already described) (1,2), mostly for adequate “hyperhydratation” purposes (3,4). The procedure had been performed uneventfully by a trained endoscopist using a “pull-type” technique (1,2). During the procedure of laparotomy, the gastrostomy tube was found to be passing through the left lobe of the liver (Fig. 1). The whole tube tract was well covered by adhesion, with no leaks, and the balloon was well positioned into the stomach. The tube was removed for the transplant and repositioned at the end of the operation.



A liver injury related to a percutaneous gastrostomy tube placement is rare (4,5). A single transhepatic tube placement had been reported earlier (6). Injuries can be avoided by using a careful technique with the usual precautionary steps. The more recent introducer (Trocar and T-Fastener) techniques are associated with a lower complication rate and should be recommended (2). In this case, the tube balloon had been correctly positioned into the gastric lumen. The compression of the intermediary structures (liver) as imposed by the technique itself ensured that hemostasis was achieved and that the tract was sealed with no complication afterward.

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1. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, et al. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20:7739–7751.
2. Gang MH, Kim JY. Short-term complications of percutaneous endoscopic gastrostomy according to the type of technique. Pediatr Gastroenterol Hepatol Nutr 2014; 17:214–222.
3. Cochat P, Hulton SA, Acquaviva C, et al. Primary hyperoxaluria type 1: indications for screening and guidance for diagnosis and treatment. Nephrol Dial Transplant 2012; 27:1729–1736.
4. Ellis SR, Hulton SA, McKiernan PJ, et al. Combined liver–kidney transplantation for primary hyperoxaluria type 1 in young children. Nephrol Dial Transplant 2001; 16:348–354.
5. Schrag SP1, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007; 16:407–418.
6. Chaer RA1, Rekkas D, Trevino J, et al. Intrahepatic placement of a PEG tube. Gastrointest Endosc 2003; 57:763–765.
© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,