Chronic amputation stump sinus secondary to bone wax

A major complication of the percutaneous endoscopic gastrostomy is inadvertent tube removal. Also termed tube dislodgement, it occurs when the retainer balloon deflates or the patient pulls on the tube unexpectedly. If it happens soon after tube placement, leaked gastric contents can cause peritonitis. For proper medico-legal management of this potentially lethal complication, the patient needs hospitalization. When it happens late, the track has matured, and peritonitis is unlikely. However, hospitalization is still needed because definitive tube replacement requires endoscopic or radiographic confirmation. Therefore, a tube accident, regardless of when, where or how it happened, requires a hospital or the facilities associated with it. Inadvertent removal and dislodgement are euphemisms because they hide the trauma and costs of this complication. In contrast, the tube of the twin-stoma gastrostomy cannot fall out. Security is inherent in its loop design (Fig. 1). Surprisingly, the security does not come at the expense of ease of tube replacement. Thus, it may be more suitable for patients who cannot give perfect cooperation with the care of their tube, as in the case of patients with mental retardation or dementia. Simply put, to keep the tube securely in place, the twin-stoma gastrostomy is a useful variation.