Small bowel perforation caused by a retained percutaneous endoscopic gastrostomy tube flange

A method used at some centers to remove or replace percutaneous endoscopic gastrostomy tubes is to cut the tube at the skin level, allowing the internal flange to be eliminated intestinally. This is known as the cut-and-push technique. This report describes a case in which the internal flange resulted in intestinal perforation in a patient with no history of underlying intestinal disease or abdominal surgery. This case illustrates the importance of interval abdominal radiographs to confirm extrusion of the internal flange.