Management of a traumatic gastric ulcer with a low-profile gastrostomy tube.

Since the advent of percutaneous endoscopic gastrostomy (PEG) tubes in 1980, they have become the device of choice for providing long-term enteral nutrition. Despite their overall safety, a number of complications can occur after PEG placement. Bleeding is usually a minor complication associated with PEG placement that occurs soon after the procedure and is most often caused by puncture of an abdominal wall vessel. More severe bleeding can occur when a branch of one of the gastric arteries is punctured. There are only a few case reports of traumatic gastric ulceration secondary to the internal bolster of a PEG. The internal bolsters are either balloons or dome shaped, and are 1.5-2.0 cm in height. We report a case in which a patient developed hemorrhage from a gastric ulcer induced by a balloon-type PEG tube that was resolved only after replacement with a tube manufactured with a low-profile internal bolster that was only 0.3 mm in height. The protruding tip of a balloon-type gastrostomy tube was believed to have caused traumatic injury to the gastric mucosa in our patient, causing ulceration. Usually, removal of the tube and placement in a different location may solve the problem. However, we believe that the PEG tube fashioned with a low-profile internal bumper is a safer option.