This case involves a stroke patient who underwent an endoscopic PEG tube placement and deteriorated shortly thereafter. A CT scan showed significant evidence of pneumo-peritoneum, likely related to gastrostomy tube placement. An exploratory laparotomy was performed the same day and the report stated that the gastrostomy tube was visualized and the stomach had relaxed and pulled away from the anterior abdominal wall allowing leakage of gastric contents into the abdomen. The patient died the following day due to severe sepsis.
Question(s) For Expert Witness
- 1. Was this patient's deteriorating medical status linked to the improper PEG tube placement?
Expert Witness Response E-004817
Pneumoperitoneum is a relatively common post PEG placement and is usually of no consequence. There is documentation in the medical literature of dislodgement of the tube if it was not secured properly which would ultimately require a laparotomy. Immune compromised patients are more likely to succumb to sepsis than patients with an “intact” immune system. I would be happy to review the case to determine if the proper technique was incorporated in the placement of the PEG.
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