The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Endoscopic Closure of a Gastric Perforation Developing as a Complication after Percutaneous Endoscopic Gastrostomy Insertion

경피적내시경위조루술 후 발생한 위천공의 내시경적 봉합 1예

  • Pih, Gyu Young (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Na, Hee Kyong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 피규영 (울산대학교 의과대학 서울아산병원 내과) ;
  • 나희경 (울산대학교 의과대학 서울아산병원 내과)
  • Received : 2017.06.14
  • Accepted : 2017.07.04
  • Published : 2018.06.01
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Abstract

Percutaneous endoscopic gastrostomy (PEG) is a relative safe but invasive procedure associated with both minor and major complications. Gastric perforation is one of the major complications, usually requiring surgical intervention. As most patients undergoing PEG have severe, chronic underlying diseases and are in a poor general condition, surgical intervention may substantially increase the risk of subsequent complications. A 75-year-old female suffering from an advanced glioblastoma underwent PEG to allow enteral nutrition in a local hospital. Four days later, she presented with fever and confusion. Three days after that, she presented with a generalized tonic-clonic seizure and was referred to the Asan Medical Center emergency room. Diagnostic work-up revealed PEG tube dislocation and a gastric wall defect. Therefore, the PEG tube was removed and endoscopic primary closure was performed using a detachable snare, hemoclips, and fibrin glue. Three weeks after closure, fluoroscopy revealed no leakage and the patient resumed enteral feeding without any complication.

경피적내시경위조루술은 비교적 안전하지만 침습적인 시술로 크고 작은 합병증들이 보고되었다. 위 천공은 주요 합병증 중 하나이며, 일반적으로 수술적 처치가 필요하다. 경피적내시경위조루술을 받는 대부분의 환자가 중증 만성 기저 질환을 가지고 있으며 전반적인 컨디션이 좋지 않기 때문에 수술을 시행하게 되면 수술 관련한 후속 합병증이 발생할 위험이 크다. 본 증례에서 진행된 뇌교종을 앓고 있는 75세 여자가 외부 병원에서 경장 영양을 위한 경피적내시경위조루술을 시행받았다. 시술로부터 4일 후 발열과 의식 혼돈을 보였으며 그로부터 3일 후 전신 긴장성 간대성 발작이 발생하여 본원 응급실로 전원되었다. 진단적 검사 결과 위루관의 탈구와 위벽 결함이 확인되었다. 이에 위루관을 제거하였고 위벽은 박리성 올가미, 금속 클립, 피브린 글루를 이용하여 내시경적 봉합을 하였다. 시술 3주 후 시행한 조영제 투시검사에서 누출이 없음을 확인하였고 합병증 없는 상태로 경장영양을 재시작하였다.

Keywords

References

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