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Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure

Patient: Female, 76 Final Diagnosis: Septic shock secondary to liver abscesses and gastro-hepatic fistula from PEG displacement Symptoms: Acute delirium Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course BACKGROUND: Percutaneous endos...

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Autores principales: Rafiq, Arsalan, Abbas, Naeem, Tariq, Hassan, Nayudu, Suresh Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588675/
https://www.ncbi.nlm.nih.gov/pubmed/26402902
http://dx.doi.org/10.12659/AJCR.895098
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author Rafiq, Arsalan
Abbas, Naeem
Tariq, Hassan
Nayudu, Suresh Kumar
author_facet Rafiq, Arsalan
Abbas, Naeem
Tariq, Hassan
Nayudu, Suresh Kumar
author_sort Rafiq, Arsalan
collection PubMed
description Patient: Female, 76 Final Diagnosis: Septic shock secondary to liver abscesses and gastro-hepatic fistula from PEG displacement Symptoms: Acute delirium Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a procedure used most commonly for enteral access for nutrition and continuation of treatment in patients when oral nutrition is not possible. It is a safe, cost-effective procedure; however, has its own complications and adverse effects that can be life threatening. CASE REPORT: Here, we present the case of a 76-year-old woman who was sent to a long-term skilled nursing facility after discharge from a hospital a month before, initially admitted for seizures after a fall and diabetic ketoacidosis. She underwent tracheostomy for prolonged respiratory support on mechanical ventilation and also underwent PEG tube placement. She presented in our Emergency Department (ED) with septic shock and multi-organ failure initially attributed to urinary tract infection and possible Clostridium difficile colitis. However, on further evaluation she was found to have a dislodged PEG tube, which led to development of gastro-hepatic fistula and multiple liver abscesses with liver necrosis. Comfort measures were implemented and she died due to her critical condition. CONCLUSIONS: To the best of our knowledge, this is the first case of a PEG tube, with no post-procedure complications, that dislodged and resulted in formation of a gastro-hepatic fistula and multiple liver abscesses. It is the first case that describes liver injury resulting from dislodgement rather than the liver being injured during the procedure of PEG tube placement itself.
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spelling pubmed-45886752015-10-07 Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure Rafiq, Arsalan Abbas, Naeem Tariq, Hassan Nayudu, Suresh Kumar Am J Case Rep Articles Patient: Female, 76 Final Diagnosis: Septic shock secondary to liver abscesses and gastro-hepatic fistula from PEG displacement Symptoms: Acute delirium Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology OBJECTIVE: Unusual clinical course BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a procedure used most commonly for enteral access for nutrition and continuation of treatment in patients when oral nutrition is not possible. It is a safe, cost-effective procedure; however, has its own complications and adverse effects that can be life threatening. CASE REPORT: Here, we present the case of a 76-year-old woman who was sent to a long-term skilled nursing facility after discharge from a hospital a month before, initially admitted for seizures after a fall and diabetic ketoacidosis. She underwent tracheostomy for prolonged respiratory support on mechanical ventilation and also underwent PEG tube placement. She presented in our Emergency Department (ED) with septic shock and multi-organ failure initially attributed to urinary tract infection and possible Clostridium difficile colitis. However, on further evaluation she was found to have a dislodged PEG tube, which led to development of gastro-hepatic fistula and multiple liver abscesses with liver necrosis. Comfort measures were implemented and she died due to her critical condition. CONCLUSIONS: To the best of our knowledge, this is the first case of a PEG tube, with no post-procedure complications, that dislodged and resulted in formation of a gastro-hepatic fistula and multiple liver abscesses. It is the first case that describes liver injury resulting from dislodgement rather than the liver being injured during the procedure of PEG tube placement itself. International Scientific Literature, Inc. 2015-09-24 /pmc/articles/PMC4588675/ /pubmed/26402902 http://dx.doi.org/10.12659/AJCR.895098 Text en © Am J Case Rep, 2015 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License
spellingShingle Articles
Rafiq, Arsalan
Abbas, Naeem
Tariq, Hassan
Nayudu, Suresh Kumar
Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title_full Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title_fullStr Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title_full_unstemmed Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title_short Gastro-Hepatic Fistula with Liver Abscess: A Rare Complication of a Common Procedure
title_sort gastro-hepatic fistula with liver abscess: a rare complication of a common procedure
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4588675/
https://www.ncbi.nlm.nih.gov/pubmed/26402902
http://dx.doi.org/10.12659/AJCR.895098
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