Stool studies for C difficile toxin are positive and the patient is started on oral Vancomycin 125 mg via PEG tube 4 times a day
The frequency of diarrhea improves, and eventually the patient is discharged to a skilled nursing facility.
3 months later you are reconsulted on the same patient who is brought in for clogged tube and moderate leakage around the PEG tube site.
Abdominal exam reveals erythema at the tube site, with some surrounding serous discharge. The external bumper is noted at 2cm and the tube cannot be easily rotated or advanced within the tract. Attempts to rotate the tube in the tract cause severe pain. You are unable to flush the PEG tube with water.
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