Patient Discharged From Hospital With Dislodged Feeding Tube

Case Overview

This case involves a male patient who underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube. While the physician was awaiting confirmation that the PEG tube had been placed properly, the patient’s PEG tube became dislodged. The patient was subsequently discharged from the hospital without confirmation that the PEG tube was functional. An expert in gastroenterology was sought to discuss the standard protocols used to confirm the correct placement of the PEG tube.

Questions to the General Surgery expert and their responses

What has been your experience managing dislodged PEG tubes?

I have significant experience in the diagnosis and managing PEG tube complications. I have received numerous referrals for difficult PEG access, dislodged PEG, buried bumper syndrome, peritonitis, and even necrotizing soft tissue infections from dislodged PEG. I have repaired these using a variety of endoscopic, laparoscopic, and open techniques. I organized a symposium on management of PEG tube complications at the annual meeting of a parenteral nutrition society and have given several talks on the topic.

What are the standard protocols used to confirm the correct placement of the PEG tube?

There is no standard protocol for verifying PEG but verification generally consists of careful physical exam, tube injection study, CT scan if there is concern about the site. It is important to note a tube injection study alone can fail to diagnose a dislodged PEG, particularly if there is buried bumper syndrome.

About the expert

This expert has over 10 years of experience in general surgery and surgical critical care. He earned his BS in chemistry and an MD from Duke University. He went on to complete an internship and residency in general surgery, as well as a fellowship in critical care surgery at Ohio State University. This expert is board-certified in both general surgery and surgical critical care. He is active in his field as a member of multiple prestigious societies, including the American Association for the Surgery of Trauma and the Society of Critical Care Medicine. Additionally, he has published over 115 peer-reviewed articles and over 110 abstracts in the field. Previously, this expert served as a clinical instructor of surgery, an associate professor of critical care surgery, an assistant medical director in trauma, and a medical director of surgical services and trauma, all at Ohio State University. He has also held a position as an associate medical director at the Worthington Division of Fire & EMS. Currently, he serves as an attending surgeon of trauma and critical care at two hospitals, an adjunct clinical professor of surgery at a known university, and the medical director of nutrition and the transfer center at a health system in Ohio.