Laparoscopy-Assisted Percutaneous Endoscopic Gastrostomy in a Patient with Distorted Anatomy / 대한내과학회지

Percutaneous endoscopic gastrostomy (PEG), which was first introduced in 1980, was quickly adopted for use in pediatric and adult patients. However, problems such as severe kyphoscoliosis, interposed organs, or other forms of distorted anatomy, may prevent effective and safe PEG tube placement. In such cases, laparoscopy-assisted PEG (LAPEG) is a useful optional procedure for patients with distorted anatomy and an initial unsuccessful PEG attempt. Furthermore, less invasive measures are preferable over surgical gastrostomy. We present a 27-year-old-male patient with severe kyphoscoliosis and a history of PEG-related complications with a colocutaneous fistula appearing 10 months earlier in whom a feeding tube was successfully placed by LAPEG. There were no LAPEG-related complications in the perioperative period, either technical or metabolic. After discharge, the patient was effectively fed using the bolus method.

An Unusual Complication of Total Parenteral Nutrition via Subclavian Vein Catheterization Masquerading as Bilateral Chylothorax

Chylothorax, a relatively rare condition of pleural effusion, is defined as an accumulation of chyle resulting from damage to the thoracic duct associated with chyle leakage from the lymphatic system into the pleural cavity. The etiologies of this condition are numerous, and the most important approach for management of chylothorax is to determine the definite cause. We report on a case of an unusual complication of chylothorax that occurred after central catheterization and direct instillation of total parenteral nutrition into the pleural cavity.