A 55-year-old man who suffered from cancer of the larynx was referred 6 months ago
for endoscopic percutaneous gastrostomy tube (PEG) for feeding. The PEG was placed
using an ultrathin scope to pass the throat mass. The patient received multiple chemotherapy
and radiotherapy sessions. The patient’s family came to the emergency room when they
noticed worms in his undershirt. The abdomen was lax on examination, and on removal
of the old dirty dressing, a lot of maggots were seen moving around the gastrostomy
tube ([Fig. 1]
,
[Video 1]). Mild cellulitis was noted in the surrounding area. The dermatologist and surgeon
were consulted, and irrigation, larvae extraction, and a petroleum jelly dressing
were applied successfully. Topical antibiotics were prescribed. A new replacement
gastrostomy was performed successfully. Family education was provided and good hygiene
encouraged.
Maggots around the gastrostomy tube.Video 1
Fig. 1 Maggots around the gastrostomy tube.
Myiasis is an unusual maggot (larval) infestation of living organisms. Clinically
there are two types, namely “obligate,” which is travel-associated, and opportunistic
“facultative or traumatic,” which is commonly seen in necrotic wounds [1]. Obligate myiasis is caused by two flies: Dermatobia hominis (bоtfly) and Cordylobia anthropophaga (tumbu fly). The larvae commonly penetrate the skin and the underlying tissue. Usually,
the insect bite progresses to a nodule that may ooze serosanguineous fluid, causing
skin irritation and itching. Myiasis may be complicated by secondary bacterial infection
[2].
Wound myiasis is caused by the Calliphoridae (blowfly or screwworm fly), Sarcophagidae (flesh fly), and Phoridae (humpback fly) families. The condition is common with poor personal hygiene. The
common treatment is irrigation to remove the dislodged larva, larvae removal, closure
of the skin openings by an occlusive dressing, petroleum jelly and submersion using
diluted povidone-iodine solution [3].
In the literature, two cases were published reporting myiasis around the percutaneous
gastrostomy tube [4]
[5]. The first case was a 71-year-old suffering from diabetes mellitus, hypertension,
and an old stroke who needed a feeding gastrostomy tube. The other case was a 55-year-old
with metastatic squamous cell carcinoma who needed a feeding gastrostomy tube. In
conclusion, myiasis is an uncommon complication of a gastrostomy tube in a patient
with poor hygiene.
Endoscopy_UCTN_Code_CPL_1AH_2AI
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
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by Research4Life (see: https://www.research4life.org/access/eligibility/).
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