Article ID: 15-10
A male in the 70’s with Parkinson’s disease underwent percutaneous endoscopic gastrostomy （PEG） using the introducer method. Following needle puncture, massive intragastric bleeding was observed, and surgical rescue was initiated. The patient remained hypotensive despite fluid resuscitation. Resuscitative endovascular balloon occlusion of the aorta （REBOA） was deployed in Zone 1, achieving partial hemodynamic stabilization. Contrast-enhanced CT revealed active extravasation from the abdominal aorta. Emergency laparotomy identified a small damage of the abdominal aorta, which was successfully sutured. Gastric wall injuries were also repaired, and a feeding tube was reinserted. Postoperatively, the patient received intensive care, including transfusion of 12 units of red blood cells and 6 units of fresh frozen plasma. He recovered steadily and was discharged on hospital day 114. To our knowledge, this is the first reported case of aortic injury during PEG in Japan. This case highlights the importance of surgical preparedness in invasive procedures involving frail patients.
