Refusal of PEG Feeding Following a Carotid Endarterectomy

This case study presents a patient who has undergone right carotid endarterectomy complicated by glossopharyngeal nerve (or cranial nerve (CN) IX) injury. The patient had one transient ischaemic attack (TIA) three weeks before admission. A computed tomography (CT) scan two days after admission illustrated a right-sided parietal infarct. The patient subsequently had a CT angiogram, which showed a large, calcified plaque in the right internal carotid artery. He then underwent a right carotid endarterectomy. After the procedure, he developed dysphagia. A discussion was had with the patient about using percutaneous endoscopic gastrostomy (PEG) to provide a means of feeding. The patient subsequently refused this in favor of nasogastric tube (NGT) feeding despite the doctor’s advice. This highlights an important learning point with regards to patient autonomy and their right to refuse treatment. Further research is required into the quality of life after PEG to help patients make an informed decision.