Which of the following is an absolute contraindication for PEG?

Massive ascites is an absolute contraindication for percutaneous endoscopic gastrostomy (PEG) placement due to the associated risks. When a patient has massive ascites, the presence of fluid in the abdominal cavity can lead to several complications during the procedure. This fluid can hinder proper visualization and access to the stomach, increase the risk of infection, and complicate the erosion of the abdominal wall through which the PEG tube is inserted. Furthermore, manipulating the area could lead to inadvertent injury to surrounding structures or exacerbate the underlying condition.

In contrast, while uncontrolled diabetes, chronic pancreatitis, and aortic aneurysms may present challenges or increase risk during procedures, they are not absolute contraindications for the PEG procedure. These conditions can often be managed with appropriate precautions and medical management to mitigate risks. Therefore, massive ascites stands out as a clear contraindication, highlighting the importance of a thorough assessment of potential complications before proceeding with PEG placement.