Passage of a percutaneous endoscopic gastrostomy tube through the liver: a case report and review of the literature

BACKGROUND: Passage of a percutaneous endoscopic gastrostomy (PEG) tube through the liver during PEG is a rare but potentially serious complication. CASE PRESENTATION: Here, we report the case of a 78-year-old male patient with dysphagia who underwent PEG in our hospital. Follow-up abdominal computed tomography (CT) revealed that the PEG tube had passed through the left lobe of the liver. This situation poses a clinical dilemma as to whether to remove the tube or allow it to remain in place. Based on existing literature, transhepatic PEG tubes can be used for long periods of time. In our case, the sinus tract was immature and there were no immediate concerns with regards to serious complications. Therefore, we decided to retain the PEG tube and observe the patient, incorporating tube care, regular disinfection, and dressing changes. The patient has been using his PEG tube for over five years with no severe complications. To the best of our knowledge, this is the longest PEG tube has been allowed to remain in place. CONCLUSIONS: The transhepatic insertion of a PEG tube is an extremely rare complication of PEG. Our experience indicates that a PEG tube can be retained and used for a long period of time in the absence of serious complications related to a transhepatic PEG tube. Caregivers should pay particular attention to the disinfection and daily management of PEG tubes.