Abstract
Liver injury related to percutaneous endoscopic gastrostomy (PEG) placement is a rare major complication. We experienced massive subcapsular hepatic hematoma and intraperitoneal hemorrhage after PEG successfully managed conservatively. A 92-year-old woman with dementia was referred for PEG insertion because of appetite loss. CT revealed hepatomegaly of the lateral segment. After 1 : 1 finger compression and transillumination of the abdominal wall were confirmed, gastropexy using Funada's gastropexy device was performed at the site of puncture, and the 20Fr bumper-type-catheter was pushed into the stomach (Kangaroo Seldinger PEG kit, Nippon Sherwood) without difficulty. Fluologram showed the tip of the PEG tube in the stomach without peritoneal leakage. Four days after PEG, she developed hypotension and decreasing hemoglobin levels. Urgent CT demonstrated massive subcapsular hepatic hematoma in the lateral segment, intraperitoneal fluid and PEG tube without definite penetration of hepatic parenchyma. Given the high suspiction of hepatic injury, trascatheter arterial embolization was performed and she recovered with additional conservative management. She was transferred to the next hospital on 118 days after PEG. In conclusion, since liver injury associated to PEG with gastropexy may potentially cause fatal hemorrhage or result in abscess formation, it should be kept in mind.
