Amyotrophic lateral sclerosis (ALS), the most common motor neuron disease, is characterized by motor neuron degeneration in the primary cortex, brains-tem, and spinal cord. Percutaneous endoscopic gastrostomy (PEG) is a preferable method of nutritional support in patients with normal gastrointestinal function who cannot be fed orally for various reasons. PEG tube placement is recommended in amyotrophic lateral sclerosis (ALS) patients with dysphagia to provide reliable access for medications and nutrition. We report a case of a 63-year-old man with amyotrophic lateral sclerosis presenting with dysphagia and pneumoperitoneum following percutaneous endoscopic gastrostomy (PEG) placement. We also report on the intensive care period of this patient. PEG is a widely used nutrition therapy in these cases but complications such as pneumoperitoneum result in long term ICU stays and higher mortality rates.