Successful complication management of a colon perforation after PEG implantation with the OTSC-system

A 75-year-old patient ocurred one day after percutaneous endoscopic gastrostomy (PEG) with a Hb-relevant peranal hemorrhage. The colonoscopy performed at the same day revealed a perforation of the PEG tube through the transverse colon as the source of bleeding. The patient was transferred to our clinic for endoscopic closure of both the perforations of the stomach and colon caused by the PEG-tube. A colonoscopy was performed with the preinstalled OTSC-system® and the cap on the endoscope. The margins of the colonic perforations were secured by the „twingrasper®“. This was followed by gastroscopic extraction of the PEG-tube. As soon as the PEG-tube was withdrawn from the colon, the 10mm traumatic clip (12/6gc) was applied for the closure of both perforations of the colon. Because of this simultaneous approach, only a minimal quantum of air leaked into the peritoneal cavity. The remaining perforation of the stomach was closed afterwards, again with a 10mm traumatic OTSC-system® (12/6gc).

Abb. 1–4: Endoscopic closure of the perforations with OTSC