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Korean J Gastroenterol  <  Volume 72(6); 2018 <  Articles

Korean J Gastroenterol 2018; 72(6): 308-312  https://doi.org/10.4166/kjg.2018.72.6.308
Percutaneous Endoscopic Gastrostomy Tube Insertion-induced Superior Mesenteric Artery Injury Treated with Angiography
Seo Hee Lee, Hee Seok Moon , Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung,
Byung Seok Lee and Hyun Yong Jeong
Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
Correspondence to: Hee Seok Moon, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-280-7163, Fax: +82-42-257-5753, E-mail: mhs1357@cnuh.co.kr, ORCID: https://orcid.org/0000-0002-8806-2163
Received: April 25, 2018; Revised: May 28, 2018; Accepted: June 12, 2018; Published online: December 25, 2018.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.
Keywords: Gastrostomy; Endoscopy; Hemorrhage; Angiography


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