S5431 Intra-Abdominal Hemorrhage Following Percutaneous Endoscopic Gastrostomy Tube Placement With Transhepatic Course

Introduction: Percutaneous endoscopic gastrostomy (PEG) tube placement involves a complex decision-making process based on multiple factors to optimize patient care and quality of life. As PEG tube placement becomes increasingly common worldwide, a corresponding rise in reported complications, both minor and major, has been observed. Case Description/Methods: A 75-year-old woman was admitted for acute hypoxic respiratory failure (AHRF) with suspected CO₂ narcosis, dysphagia, and altered mental status secondary to her known history of amyotrophic lateral sclerosis (ALS). She underwent PEG tube placement due to progressive ALS-associated dysphagia. Post-procedurally, the patient developed severe anemia and abdominal pain, prompting further evaluation, which revealed a small amount of blood near the spleen and stomach on imaging, suggestive of transhepatic PEG tube placement. Conservative management was initially employed, but continued complications necessitated surgical intervention to replace the PEG tube. Discussion: Conservative management was initially employed, but continued complications necessitated surgical intervention to replace the PEG tube. This case highlights a rare complication, transhepatic PEG placement, and underscores the importance of individualized management strategies in high-risk patients with complex medical histories.