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Stomal Metastases Complicating Percutaneous Endoscopic Gastrostomy: CT Findings and the Argument for Radiologic Tube Placement

¹ Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5600.
² Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814.
³ Department of Radiology, University of Washington, 1959 N.E. Pacific, Box 357115, Seattle, WA 98195-7115.
⁴ Gastroenterology Service, Walter Reed Army Medical Center, Bldg. 2, 7F, 6900 Georgia Ave., N.W., Washington, DC 20307.

OBJECTIVE. This article describes the CT appearance of metastatic implantation at the percutaneous endoscopic gastrostomy (PEG) tract in patients with malignancy of the upper aerodigestive tract. Cumulative data from previous case reports are also considered for insight into causes of metastasis and the implications for gastrostomy placement in these patients.

CONCLUSION. CT showed lobulated soft tissue involving the entire abdominal wall PEG tract in all proven cases. CT is an effective method for evaluation because the tumor burden lies predominately in the abdominal wall and not at the entry or exit site. The stomal implant is often the only site of metastatic disease at presentation. In general, CT findings of mildly increased soft tissue along the PEG tract are nonspecific, but a lobulated mass is highly suspicious for tumor implantation, especially if the one-sided thickness exceeds 1 cm. The preponderance of evidence from the existing literature points to direct tumor implantation during endoscopic placement as the likely cause (rather than hematogenous spread). This conclusion would support the alternative of radiologic tube placement in these patients.

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