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Metastases to the abdominal wall after percutaneous endoscopic gastrostomy in patients with head and neck cancer: four case reports. A percutaneous endoscopic gastrostomy (PEG) is often inserted to prevent excessive weight loss in patients with head and neck cancer undergoing locoregional treatment. The pull-through technique is commonly used, although it involves direct contact with the tumour and therefore some risk of development of metastases at the gastrostomy site. We present four cases with different presentations of this rare complication. Clinicians should have high suspicion of abdominal wall metastases when problems occur at the ostomy site and should readily perform a biopsy to establish an early diagnosis. Alternative strategies to prevent malnutrition during primary treatment for squamous cell carcinoma of the head and neck should be considered when the risk of tumour seeding is high.