NONSURGICAL MANAGEMENT OF GASTRIC OR DUODENAL PERFORATION FROM A WILLS-OGLESBY-TYPE GASTROSTOMY TUBE

PURPOSE: To describe the clinical and radiologic appearance of gastroi ntestinal perforation related to a Wills-Oglesby-type gastrostomy tube , as well as techniques for nonsurgical management. MATERIALS AND METH ODS: Five patients with a previously placed 14-F modified Wills-Oglesb y-type gastrostomy catheter experienced viscus perforation by the dist al limb of the catheter during a 30-month period. RESULTS: The average interval between tube placement and perforation event was 4.3 months. Three patients had migration of the gastrostomy tube into the duodenu m and subsequent duodenal perforation. One patient had posterior perfo ration of the stomach, and one patient developed a gastrocolic fistula . Generalized peritonitis was not present in any patient. All patients were treated successfully without surgery, and tube feedings were re- established in 4-14 days. CONCLUSIONS: Gastrostomy tube-related perfor ation is an uncommon, delayed complication of percutaneous gastrostomy with the modified Wills-Oglesby-type catheter. Nonsurgical management is feasible in select instances. Because of these gastrointestinal pe rforations, the gastrostomy tube has been modified (eliminating the di stal tip), and no gastrostomy-associated gastrointestinal perforation has been experienced since.