how can this happen

pegtube incertion ended up in lung?????

IR or GI?

David Carpenter, PA-C

Are you sure you don't mean an NG (nasogastric)tube? I really don't think it's even remotely possible that a PEG (percutaneous endoscopic gastrostomy) tube could end up being placed in the lung. Lots of people get NGs, Dobhoffs, PEGs and JTubes mixed up.

Is the tube entering the body through the nose or the abdomen?

I didn't think about it being an NG tube. I've seen really high PEG tubes put in by IR that were right under the ribs. Theoretically it could end up in the lung but that should be apparent. On the other hand working in an academic medical center I could totally believe that this could happen.

David Carpenter, PA-C

I haven't seen a PEG placed recently, but they used to be placed only with the help of endoscopy. The endoscopy tube would be inserted into the stomach (no mistaking it for the lung), the stomach expanded with air, the tube introduced percutaneously and observed in the stomach, and finally the bulb filled.

NGs, on the other hand, end up in all kinds of weird places. I even heard about one ending up in the brain of a patient who had crainiofacial surgery.

With IR they insuflate the stomach with an NG like device and then use a needle to enter the stomach from the outside to introduce the PEG. I can see transecting the lung if someone really doesn't know what they are doing. Going between the ribs would be the first indication.

David Carpenter, PA-C

entering the abdomen.....this was replacing a pegtube...due to the old one being occluded...followed all procedures..stop was at 6 cm mark...18 fr/15cc ballon....done many times before on others?????

If I am understanding you you replaced a PEG tube through the same tract and the tip of the PEG tube ended up in the lung (and by lung I am assuming you mean pleural space)?

I think that this would be almost impossible. The only way that I could conceive of it happening is that somehow the tract broke down and you went between the stomach and the abdominal wall then through the diaphragm. I have a hard time seeing this done with 6cm of PEG. If it was one of the mushroom types I have seen people perforate various organs with the trocar but a MIC type would be pretty much impossible.

David Carpenter, PA-C