The Use of a Tunneled Ascitic Drain to Allow Percutaneous Radiologic Insertion of a Gastrostomy

The potential complications of a percutaneous radiologically inserted gastrostomy (RIG) in a patient with ascites are well established. The presence of a significant volume of ascites leads to poor apposition of the stomach to the anterior abdominal wall and the potential for leakage of gastric contents and subsequent peritonitis. Failure of the tract to mature, peristomal leakage and tube displacement may also occur [1, 2]. Several previous publications have described techniques to allow safe RIG insertion in patients with ascites. These have largely depended on preprocedural paracentesis followed by serial ultrasounds and repeated paracentesis as necessary and/or the use of T-fastener gastropexy to prevent complications [3–5]. We describe a modification of this technique using a permanent tunneled drainage catheter to obviate the need for repeated imaging and intervention whilst the gastrostomy tract matures.