Case Report
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World J Gastrointest Oncol. Nov 15, 2013; 5(11): 204-206
Published online Nov 15, 2013. doi: 10.4251/wjgo.v5.i11.204
Rare complication of percutaneous endoscopic gastrostomy: Ostomy metastasis of esophageal carcinoma
Ana Lúcia Sousa, Diamantino Sousa, Francisco Velasco, Francisco Açucena, Ana Lopes, Horácio Guerreiro
Ana Lúcia Sousa, Diamantino Sousa, Francisco Velasco, Francisco Açucena, Horácio Guerreiro, Department of Gastroenterology, Hospital de Faro E.P.E., 8000-386 Faro, Portugal
Ana Lopes, Department of Internal Medicine, Hospital de Faro E.P.E., 8000-386 Faro, Portugal
Author contributions: Sousa AL and Sousa D contributed equally to this work; Sousa AL and Sousa D designed and wrote the article; Velasco F and Açucena F placed the percutaneous endoscopic gastrostomy and critically revised the article; Lopes A was attending doctor for the patient in the Nutrition Team and critically revised the article; Guerreiro H approved the final version to be published.
Correspondence to: Ana Lúcia Sousa, MD, Department of Gastroenterology, Hospital de Faro E.P.E., Rua Leão Penedo, 8000-386 Faro, Portugal. ana.e.sousa@hotmail.com
Telephone: +351-91-4234342 Fax: +351-289-891211
Received: August 28, 2013
Revised: September 30, 2013
Accepted: October 11, 2013
Published online: November 15, 2013
Processing time: 72 Days and 4.5 Hours
Abstract

The authors present the case of a 55-year-old male with a stage III (T4N1M0) squamous-cell esophageal carcinoma, who underwent percutaneous endoscopic gastrostomy (PEG). The pull method of tube placement was used. Five months after the procedure, the patient was referred to the hospital with a hard palpable tumour at the ostomy site. The histologic exam revealed an abdominal wall metastasis of the esophageal cancer. The authors present this case because of the rarity of metastasis in ostomy after placement of PEG in patients with tumours located in the head and neck. In this particular context and judging by the rarity of situation, the clinical impact of this phenomenon is limited. Nevertheless, metastasis in ostomy site could be prevented by the push method, laparoscopy or laparotomy.

Keywords: Enteral nutrition; Gastrostomy; Esophageal neoplasms; Neoplasm metastasis; Ostomy

Core tip: We present this case to alert endoscopists to the possibility of metastatic cells in the ostomy when the percutaneous endoscopic gastrostomy is the chosen method for the nutrition support of the patient with head and neck cancer. This is a very rare but a possible complication so, in these situations, probably we must think about other possibilities of tube placement namely using an overtube, the introducer method or performing a surgical gastrostomy.