Ultrasound-assisted Percutaneous Endoscopic Gastrostomy in a Patient with Advanced Ovarian Carcinoma and Recurrent Intestinal Obstruction

We report a case of recurrent bowel obstruction in a 56-yr-old woman secondary to progressive ovarian carcinoma. Due to a history of multiple prior surgeries, intraperitoneal chemotherapy, radiotherapy, and progressive intra-abdominal disease, placement of a percutaneous endoscopic gastrostomy (PEG) for decompression was thought to carry significant risk if standard techniques were used. We therefore used transcutaneous ultrasound imaging at the time of endoscopy, which allowed for rapid localization of an appropriate area for PEG placement, thereby minimizing the risk of inadvertently entering adjacent organs or metastatic foci. To our knowledge, this is the first such case in which ultrasound-assisted PEG placement has been utilized.