Percutaneous endoscopic gastrostomy (PEG) is widely used for long-term enteral nutrition in patients unable to maintain adequate oral intake. Despite advancements in PEG techniques, complications remain a concern. We report a case of a 94-year-old bedridden man who developed significant complications after PEG placement using the pull method. Initially, minor bleeding at the puncture site was managed using traction compression. However, the patient later experienced hemorrhagic shock owing to pulsatile bleeding around the gastrostomy site. Despite attempts to control the bleeding through traction and transfusions, a pseudoaneurysm adjacent to the PEG button was identified. The patient underwent successful transcatheter arterial embolization (TAE). Post-TAE, no further bleeding or hematoma was observed, and imaging confirmed the resolution of the pseudoaneurysm and hematoma. Methicillin-resistant Staphylococcus aureus (MRSA) infection was detected at the gastrostomy site, which contributed to complications. Despite successful management of the bleeding, the patient\'s overall condition deteriorated, and he died on postoperative day 66. This case underscores the importance of vigilant monitoring and management of PEG-related complications, particularly infections that may precipitate severe vascular events.

BACKGROUND: There are no reports of anesthesia use in adult patients with Silver-Russell syndrome (SRS). Here, we report our experience with anesthesia in an adult patient with SRS complicated by chronic respiratory failure.
METHODS: A 33-year-old woman was clinically diagnosed with SRS. She had severe chronic respiratory failure, complicated by superior mesenteric artery syndrome. Percutaneous gastrostomy was scheduled for nutritional management under epidural anesthesia; however, soon after esophagogastroduodenoscopy was started, she lost consciousness and spontaneous respiration. The patient was urgently intubated and converted to general anesthesia. The end-tidal carbon dioxide tension was > 90 mmHg at intubation.
CONCLUSIONS: Adult SRS patients with chronic respiratory failure have a risk of CO2 narcosis. SRS also requires preparation for difficult airway management during the perioperative period.

Surgery is often the only therapeutic option for the management of fibrotic Crohn\'s disease (FCD). Exclusive Enteral Nutrition (EEN), a nutritionally complete liquid formula, is an effective, safe, short-term treatment for Crohn\'s Disease. No cases were found internationally of adults with FCD on long-term EEN. We report on clinical outcomes and self-reported quality of life (QoL) after longer-term EEN provision in a patient with complex FCD.
\"Billie\", a 54-year-old female, was admitted with ileal FCD diagnosed in 1985. Previous treatments were unsuccessful, including multiple bowel resections. Billie was chronically bedbound with pain and depression. CDAI (Crohn\'s disease activity index) score was 640 (<150) with ∼3-20 liquid stools/day, and recurrent partial bowel obstructions. Radiological findings were so severe surgeons reluctantly considered surgery but \"one more resection will result in short bowel syndrome\". Billie trialled EEN given her QoL was \"non-existent\". Unable to tolerate the taste, EEN was administered via nasogastric tube. After two months, EEN was administered ongoing via percutaneous endoscopic gastrostomy given patient preference and dietetic advocacy.
After eight weeks on EEN, Billie\'s pain predominantly resolved, with bowel motions of ∼1-2/day, and nil bowel obstructions. Twelve months after EEN commencement, Billie\'s CDAI was 52, with \'no indication for surgical intervention\' and was self-reporting that \"life is good\". After 18 months, Billie remains asymptomatic, and in clinical remission.
This unique case is a wonderful example of dietetic advocacy and showcases the positive impact long-term EEN may have on surgical avoidance, clinical outcomes and self-reported QoL.

Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for patients with dysphagia and inadequate oral intake. Although PEG offers numerous benefits, complications can occur. Here, we present an unusual case of a 68-year-old woman who developed persistent diarrhea following a routine PEG tube exchange. Despite treatment attempts, her symptoms persisted, prompting further investigation. Abdominal computed tomography (CT) revealed the unexpected displacement of the PEG tube tip into the duodenum. Repositioning of the tube tip into the stomach resolved the diarrhea, and the patient was discharged without recurrence. Diarrhea is a common gastrointestinal side effect in patients receiving enteral nutrition through a PEG tube, typically attributed to multiple factors. However, to our knowledge, this is the first reported case of diarrhea resulting from a PEG tube tip straying into the duodenum. The patient did not undergo any changes in enteral preparation or receive medications known to cause diarrhea. The identification of the tube misplacement was incidental during the CT scan, underscoring the importance of imaging studies in refractory cases. While previous reports indicate no significant difference in diarrhea occurrence between duodenal and gastric feeding, our findings suggest that the presence of the PEG tube tip in the duodenum may contribute to diarrhea in some patients. This case highlights the potential role of CT imaging in diagnosing the cause of persistent diarrhea in PEG-fed individuals. Further accumulation of cases is necessary to establish the significance of duodenal tube placement as a cause of diarrhea during PEG procedures. In conclusion, this case report emphasizes the importance of considering tube misplacement as a potential cause of refractory diarrhea in patients receiving enteral nutrition through a PEG tube. The use of abdominal CT imaging can be valuable in identifying such misplacements and guiding appropriate interventions. Further research is needed to validate these findings and explore the clinical implications for the management of PEG-related diarrhea.

Gastrocolic fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) placement procedure. This complication occurs due to penetration of interposed colon when a PEG tube is placed into the stomach. It can go unrecognized, becoming evident only when a tube replacement is performed or tube migration occurs. We report a case of severe, intractable diarrhea occurring about one month after the PEG procedure in a patient with severe traumatic brain injury. We present our case and discuss its significance with the aim of raising clinicians\' awareness of this rare condition.

Buried bumper syndrome (BBS) is a rare but severe complication of percutaneous endoscopic gastrostomy (PEG) tube feeding. Patients with BBS lose PEG tube patency and may experience peristomal pain, content leaks, or peritonitis. An early diagnosis can avert further complications. BBS is a clinical diagnosis, but an abdominal computerized tomography scan or upper endoscopy is needed to confirm the diagnosis. BBS is a long-term complication of PEG tube feeding, and cases of acute onset are scant in the literature. We report a unique case of a 65-year-old female with a history of stroke who developed BBS five weeks after PEG tube placement.

BACKGROUND: In adults, bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder. In rare cases, this is a complication of a percutaneously placed endoscopic gastro (jejunostomy) catheter.
METHODS: We describe a case of a 73-year-old patient with a history of myocardial infarction, chronic idiopathic constipation and Parkinson\'s disease. For the admission of his Parkinson\'s medication, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) was placed. The patient presented three times at the emergency department of the hospital with intermittent abdominal pain with nausea and vomiting. There were no distinctive abnormalities from the physical and laboratory examinations. An abdominal computed tomography scan showed a small bowel intussusception. By push endoscopy, a jejunal bezoar at the tip of the PEG-J catheter was found to be the cause of small bowel intussusception. The intussusception was resolved after removing the bezoar during push enteroscopy.
CONCLUSIONS: Endoscopic treatment of bowel intussusception caused by PEG-J catheter bezoar.

BACKGROUND: Pneumoperitoneum is a common complication of percutaneous endoscopic gastrostomy (PEG). We report a case of circulatory and respiratory depression due to pneumoperitoneum caused by PEG dislodgement during endoscopic submucosal dissection (ESD) surgery.
METHODS: A 46-year-old man with PEG for dysphagia underwent ESD for esophageal cancer under general anesthesia. The patient developed a gradual increase in peak inspiratory pressure, followed by a decrease in peripheral oxygen saturation (SpO2) and blood pressure, as well as an increase in heart rate (HR) during endoscopic submucosal ESD for esophageal cancer. We suspected mediastinal emphysema due to esophageal perforation, but the surgery was successfully completed. Postoperative computed tomography (CT) revealed that the abdominal and gastric walls, which had been fixed by PEG, were detached, resulting in a large amount of intra-abdominal gas and mediastinal emphysema.
CONCLUSIONS: ESD in patients with PEG should be performed carefully because of the possibility of intraoperative PEG dislodgement and pneumoperitoneum caused by insufflation gas leakage.

Percutaneous endoscopic gastrostomy (PEG) is a common method for providing long-term enteral nutrition to patients. PEG tube placement and removal are relatively safe; generally, a PEG tube can be removed using gentle traction, and excessive bleeding is rare. The over-the-scope clip system is a new device that can be used for gastrointestinal hemostasis and for closing gastrointestinal fistulae. In the present case, a 68-year-old man had to remove the PEG tube because of persistent leakage around the PEG tube. Although it was gently removed using traction, incessant bleeding continued, with a Rockall score of 5 points, even after hemocoagulation was attempted. An over-the-scope clip device was used to achieve hemostasis and fistula closure.

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