2026 Volume 68 Issue 9 Pages 1536-1543
Abdominal aortic injuries associated with PEG is rare. Here, we encountered a case of abdominal aortic perforation caused by needle puncture during PEG, successfully treated with emergency endovascular aortic repair (EVAR). A 76-year-old woman with multiple system atrophy underwent PEG for dysphagia using the standard introducer method. During trocar insertion, the needle tip inadvertently reached the posterior wall of the stomach. Shortly postoperatively, the patient experienced hemorrhagic shock. Computed tomography revealed retroperitoneal hematoma and contrast extravasation from the abdominal aorta, confirming iatrogenic aortic injury as the bleeding source. The patient was successfully treated with emergency EVAR, and her condition stabilized. This case highlights the importance of recognizing structures anterior and posterior to the stomach during PEG. It is important to thoroughly review preoperative imaging findings and select the PEG technique based on individual risk factors.
