Migrated PEG and free gas

Discussion:

The PEG balloon sits anteriorly within the peritoneal space.  It is adjacent to the transverse colon and a loop of small bowel, but there appears to be no damage to the bowel itself.  Contrast injected into the PEG tube sits adjacent to the right psoas muscle in the peritoneal cavity.

Subsequent laparotomy confirmed that the PEG tube had been pulled through the stomach wall with the balloon inflated.  The defect in the stomach wall was closed.  No damage to the other loops of bowel.

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