Embolization by Gelatin Sponge for Tract Closure After Inappropriate Procedure of Percutaneous Endoscopic Gastrostomy: Safe Management of Hepatic Injury After Transhepatic Placement

Placement of percutaneous endoscopic gastrostomy (PEG) is generally safe and well-tolerated. Transhepatic insertion of PEG tubes is an extremely rare but serious complication. Optimal management strategies for safe removal of PEG tubes remain unclear. A 70-year-old male with hypopharyngeal cancer underwent PEG placement prior to chemoradiotherapy. The patient experienced mild puncture site pain. Progressive elevation of inflammatory markers prompted computed tomography (CT) imaging on postoperative day 2, which revealed inadvertent transhepatic catheter placement through the lateral segment. Minimally invasive removal was prioritized over surgical management to enable continuation of chemoradiotherapy. To prevent bleeding and biliary leakage, gelatin sponge (GS) was embolized for tract closure. A pull-through technique was established for emergency tract access if massive bleeding occurred. After removal of the tube, embolic material was injected under fluoroscopic and endoscopic guidance. The gastric entry site was closed with endoscopic clips. Serial CT showed no bleeding or biliary leakage, and the patient recovered uneventfully and completed chemoradiotherapy without treatment delays. Embolization of GS represents a safe and effective technique for the removal of a transhepatic PEG tube. This minimally invasive approach successfully prevented serious complications in this rare case of PEG-related hepatic injury.