Cut-down assisted percutaneous gastrostomy tube placement in morbidly obese patient

Enteral and parenteral nutrition is primarily indicated in patients that lack adequate oral intake to support their metabolic needs. Percutaneous endoscopic gastrostomy (PEG) has become the preferred procedure of choice. With the increasing prevalence of obesity in the USA, there is a need for special interventions for PEG tube placements in overweight and obese patients. Some challenges that frequently arise with obese patients include sub-optimal transillumination, insufficient abdominal landmarks and inability to estimate the abdominal and gastric walls. We present a case of a patient with persistent dysphagia requiring enteral nutrition with an unconventional placement of a PEG tube given patient’s large body habitus.