Pseudoaneurysm developed after percutaneous endoscopic gastrostomy: a report of two cases

Percutaneous endoscopic gastrostomy (PEG) is widely performed. However, despite its widespread use, complications often follow and some of them are life-threatening. We report on two patients who developed pseudoaneurysm after PEG and how the bleeding was stemmed by transcatheter arterial embolization. Case 1 is an 84-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. Blood-laced vomiting, followed by hemorrhagic shock was observed on day 21. Pseudoaneurysm less than 10 mm in diameter was observed in the gastroepiploic artery by urgent percutaneous abdominal angiography. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. Case 2 is an 89-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. On day 28, bleeding from the gastrostomy portion occurred and the patient went into shock. On urgent percutaneous abdominal angiography, pseudoaneurysm ∼5 mm in diameter was detected in the left gastric artery. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. In the present two cases, gastrostomies were created in the anterior wall of the mid body portion as suitable for PEG position, but the bleedings occurred because of pseudoaneurysm formation accompanied by damage to the gastroepiploic or the left gastric artery. Those who perform PEG on a regular basis should be aware of the possibility of pseudoaneurysm as a serious adverse event.