Newer percutaneous endoscopy gastrostomy (PEG) tubes with soft interna
l bolsters may be prone to accidental dislodgement or removal by patie
nts. When this occurs after a mature gastrocutaneous fistula has forme
d, it is of little consequence as long as a replacement tube is prompt
ly reinserted before the track closes. Blind reinsertion of a replacem
ent tube before the track is adequately mature may have serious conseq
uences, as exemplified by a patient who developed peritonitis as a res
ult of inadvertent insertion into the peritoneal cavity. We managed tw
o other patients with early accidental PEG tube removal by a period of
nasogastric (NG) suction, intravenous antibiotic drugs, and observati
on, with a new tube placed endoscopically 7-9 days later. We review th
e management of early, inadvertent dislodgement of PEG tubes.