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An Internist’s Illustrated Guide to Gastrointestinal Surgery - part 5

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Các biến chứng chủ yếu: Khát vọng Gastrocolocutaneous Thủng lỗ rò xuất huyết viêm phúc mạc hoại tử fasciitis sớm gieo hạt loại bỏ khối u dạ dày của PEG lỗ thoát ống di chuyển qua dạ dày tường nhỏ biến chứng nhiễm trùng vết mổ Peristomal ống rò rỉ | 130 Nazareno and Wu Table 3 Complications Major Complications Aspiration Gastrocolocutaneous fistula Perforation Hemorrhage Peritonitis Necrotizing fasciitis Premature gastrostomy removal Tumor seeding of PEG stoma Tube migration through gastric wall Minor Complications Peristomal wound infection Tube leakage Fragmentation Tube migration with obstruction of the pyloric channel Tube migration into small bowel significant findings detected on pregastrostomy endoscopy may lead to changes in medical management. The majority of the data on PEGs has been obtained from case reports and retrospective studies. A review of data derived from six large series evaluating PEG placement through various methods showed that successful PEG placement was accomplished in 98 of cases. Procedure-related mortality was 0.7 with aspiration and peritonitis accounting for 90 of cases. Mortality associated with the development of a major complication was 25 . Major complications were found in 1-4 of patients whereas minor complications were reported in 4-13 of cases. In another more recent review investigating data obtained from 1758 cases the reported major and minor complication rates were 2.8 and 6 respectively 10 . The data on open gastrostomies have demonstrated a wide variation in the reported morbidity and mortality. In a review of the literature the reported major complication rate for open gastrostomies ranged from less than 2 to as high as 75 with minor complication rates of 0-13 11 . Major complications following PEG placement include aspiration perforation peritonitis premature gastrostomy tube removal tube migration gastrocolocutaneous fistula hemorrhage necrotizing fasciitis and tumor seeding of the PEG stoma. Minor complications are common and include peristomal wound infection inflammation and leakage around the gastrostomy tube granulation tissue formation tube occlusion and fragmentation and tube migration. Aspiration Pneumonia Aspiration pneumonia resulting from PEG .