Gastrostomy - Medical Malpractice Lawyer
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Gastrostomy - Overview
A gastrostomy is also called a percutaneous endoscopic gastrostomy or PEG. It is a way of inserting a tube into the stomach by pushing through an incision in the abdomen. It is designed to be aided by an endoscope that visualizes the stomach so the tube can be properly inserted. This is a technique that was developed in 1980 with different variations made since that time. The most common technique used today is the pull method. PEG tube insertions by means of endoscopy are extremely common with about 10,000 procedures performed every year in Canada.
There are two main reasons why the gastrostomy tube placement is done:
The first is for feeding in people who cannot feed themselves through their mouth. These are people who have had a stroke, brain injury, ALS, cerebral palsy or other impaired swallowing issues. Some may have cancer, trauma, or recent surgery that impairs their ability to feed orally.
The second is for decompression in patients who have some kind of gastrointestinal malignancy that has led to blockage of the stomach outlet. These patients can also suffer from an ileus which impairs outflow of the stomach juices.
There are those who can’t have a gastrostomy tube placed. These are those who have low platelets, severe ascites, hemodynamic instability, intra-abdominal perforation, sepsis, abdominal wall infection where the placement should be, active peritonitis, gastric outlet obstruction if using for feeding, total gastrectomy or severe gastroparesis. Some relative contraindication for the procedure include having cancer of the esophagus, swelling of the liver or spleen, portal hypertension, ventral hernia, previous abdominal surgeries, partial gastrectomy or peritoneal dialysis.
The procedure is done under moderately heavy sedation with midazolam and fentanyl plus local anesthesia at the site of insertion. Propofol may be necessary in some cases where deeper sedation is required. The whole procedure is monitored by an anesthesiologist.
In the procedure, the endoscope is passed into the stomach and the room is dimmed so that the stomach can be seen through the abdominal wall. The stomach needs to be insufflated so that air blows up the stomach. You can give prophylactic antibiotics before this procedure to make sure there is no wound infection from the procedure. The tube is inserted through the abdominal wall and into the inflated stomach. There are bumpers that connect the stomach to the abdominal wall. The bumpers are simply donut-like shapes that are pushed up against one another so that the tube stays in place. The tube is flushed after the procedure and the end of the tube is closed off.
There are multiple complications that can happen in what seems like a relatively simple procedure. The first is cardiopulmonary compromise and possible cardiac arrest due to oversedation. There can be aspiration if the head isn’t held at 30 degrees during the procedure. The patient can have an allergic reaction to the sedative medication or to other medications, like antibiotics, given during the procedure.
There can be a local infection at the stomal site or peristomal leakage. Bleeding out of the norm can happen as a complication and you can get a pneumoperitoneum. Some patients can develop a transient gastroparesis or even more severely, an ileus. You can inadvertently perforate the small intestine or the colon. The internal bumper can migrate distally so that you get gastric outlet obstruction. The gastric wall can ulcerate if the PEG tube is longstanding. The tube can be inadvertently removed by a confused or agitated patient. You can get buried bumper system or necrotizing fasciitis, which can be fatal. Peritonitis can happen and can be fatal as well. The peg tube can seed cancer cells into the stomach or abdominal wall. You can get a colocutaneous fistula, which shows up whenever you are replacing the PEG tube.
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The medical profession which includes doctors, nurses and hospital technicians usually provides a caring service with a high standard of excellence however there are occasions when things do go wrong. Our litigation service is completely free and our medical malpractice lawyers will deal with your case using a contingency fee arrangement which means that if you don’t succeed in receiving a financial settlement then your gastrostomy lawyer won't get paid.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here