An 89-year-old woman with a history of hypertension, type 2 DM, and several repeated cerebrovascular accidents as a result of which she had right hemiplegia and swallowing disorders that had required enteral nutrition through a nasogastric tube.
According to her family and usual manifestation, placement of a percutaneous gastrostomy tube with endoscopic control was indicated.
The procedure was performed under deep sedation by an anesthesiologist and following currently recommended antibiotic prophylaxis guidelines.
The traction placement technique was carried out with set marketed by two expert endoscopists.
The patient was discharged without complications due to infection of the area, placing the catheter presy at a distance of 2-3 cm from the skin surface through an incision of approximately 1 cm. At 12 hours PEG was performed
After 48 hours, the patient was admitted to the Emergency Department of our hospital due to general deterioration; erythema, edema and induration in the abdominal wall with suppuration of purulent fluid through and around the gastrostomy orifice.
Physical examination revealed a clear worsening in general condition, intercostal retraction and signs of peripheral hypoperfusion.
The abdominal wall showed extensive crepitation, edema and erythema in the perigastrostomy region with spontaneous suppuration and pressure of purulent material by gastrostomy orifice.
Laboratory tests showed intense white blood cell count with left shift, platelet count and alterations in prothrombin and cefalin times.
It was decided to perform an urgent abdominal CAT scan that demonstrated the presence of extensive subcutaneous emphysema abdominal wall: image compatible with gastrocnemification in the region underlying the gastrostomy; important paralytic ileus and pneumoperitoneum.
Treatment was initiated with broad-spectrum antibiotics, surgical debridement of abdominal abscess and strict local wound care.
Despite all the patient died one week after the beginning of treatment.
The culture of the samples taken in the region was positive ten days after admission for Pseudomonas putrida and Acinetobacter.
