Leaking G-tube: Difference between revisions
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==Background== | ==Background== | ||
*The percutaneous gastrostomy tube (PEG) is commonly indicated in: | *The percutaneous gastrostomy tube (PEG) is commonly indicated in: | ||
**patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing | **patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing | ||
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**mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation. | **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 | *Most PEGs are 18F to 28F and may be used for 12-24mo | ||
==Clinical Features== | ==Clinical Features== | ||
*Drainage from the stoma is common | *Drainage from the stoma is common | ||
*Frequently due to a foreign body reaction to the tube | *Frequently due to a foreign body reaction to the tube | ||
*Simple foreign body reactions should be differentiated from [[cellulitis]] and [[necrotizing fasciitis]] | *Simple foreign body reactions should be differentiated from [[Special:MyLanguage/cellulitis|cellulitis]] and [[Special:MyLanguage/necrotizing fasciitis|necrotizing fasciitis]] | ||
*Leakage of gastric fluid into the peritoneal cavity may result in chemical and bacterial [[peritonitis]] | *Leakage of gastric fluid into the peritoneal cavity may result in chemical and bacterial [[Special:MyLanguage/peritonitis|peritonitis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{DDX G-tube}} | {{DDX G-tube}} | ||
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==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
==Management== | ==Management== | ||
*Simple foreign body reactions can be managed with local skin care (cleaning with hydrogen peroxide and warm water) | *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: | *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: | ||
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*Leakage of gastric fluid into the peritoneal cavity results in chemical and bacterial peritonitis; management may include: | *Leakage of gastric fluid into the peritoneal cavity results in chemical and bacterial peritonitis; management may include: | ||
**Discontinuing tube feeds | **Discontinuing tube feeds | ||
**Starting empiric [[antibiotics]] initiated | **Starting empiric [[Special:MyLanguage/antibiotics|antibiotics]] initiated | ||
**Obtain imaging and surgical consult | **Obtain imaging and surgical consult | ||
==Disposition== | ==Disposition== | ||
*Simple foreign body reaction: home with skin care teaching | *Simple foreign body reaction: home with skin care teaching | ||
*Other management in conjunction with consultant | *Other management in conjunction with consultant | ||
==See Also== | ==See Also== | ||
*[[G-tube complications]] | |||
*[[Clogged G-tube]] | *[[Special:MyLanguage/G-tube complications|G-tube complications]] | ||
*[[Displaced G-tube]] | *[[Special:MyLanguage/Clogged G-tube|Clogged G-tube]] | ||
*[[Infected G-tube]] | *[[Special:MyLanguage/Displaced G-tube|Displaced G-tube]] | ||
*[[Leaking G-tube]] | *[[Special:MyLanguage/Infected G-tube|Infected G-tube]] | ||
*[[Special:MyLanguage/Leaking G-tube|Leaking G-tube]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
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[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Symptoms]] | [[Category:Symptoms]] | ||
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Latest revision as of 23:17, 4 January 2026
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
- Leakage of gastric fluid into the peritoneal cavity may result in chemical and bacterial peritonitis
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