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Case 60: The difficult PEG tube insertion




This is an excerpt of operative video recorded through the laparoscope. The procedure is a laparoscopically assisted PEG tube insertion. When the laparoscope is withdrawn you can see the other operator (Mr Richard Cade) who is similtaneously performing an gastroscopy.

1.What would be the indication for this procedure being performed?

Difficulty localising the stomach at an attempted percutaneous approach. Which would be inability to indent the stomach with digital pressure on the abdominal wall - seen at endoscopy, and failure to transilluminate with the scope - seen through the abdominal wall skin.

2.What are the risks of blindly attempting PEG tube insertion when stomach localisation is difficult?

Visceral perforation, bleeding etc. Also trans-colonic tube placement.



Further Information
Pubmed - Laparoscopic PEG tube