Recurrent tense pneumoperitoneum due to air influxviaabdominal wall stoma of a PEG tube

Abstract

A 70 years old male on ventilatory and circulatory supp ort for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding. Radiography revealed free air in the abdomen and gastrograffin (G) study showed no extravasation into the peritoneum. The G tube was successfully repositioned with mechanical release of air. Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum. Mechanical release of air with sealing of the abdominal wound was performed. Later, the patient was restarted on tube feeding with no complications. This case demo nstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.

Pneumoperitoneum after Percutaneous Endoscopic Gastrostomy

“…2 The presence of a small amount of air in the peritoneal cavity is a benign finding due to air inflated into the gastric lumen during endoscopy. 1 In 85–91% of these cases the course is benign, with spontaneous and quick recovery (mean time to resolution was 2.7 days). 1 , 3 However, pneumoperitoneum can be a sign of a more severe complication, as intestinal perforation.…”

“… 1 In 85–91% of these cases the course is benign, with spontaneous and quick recovery (mean time to resolution was 2.7 days). 1 , 3 However, pneumoperitoneum can be a sign of a more severe complication, as intestinal perforation. The clinical challenge is the distinction between these two entities.…”

“…PEG tube placement is a safe and effective method allowing the enteric nutritional support when oral ingestion is compromised. 1 …”

“…The asymptomatic and stable patient should be kept under surveillance and usually no intervention is needed. 1 , 5 However, in the presence of abdominal pain, tenderness, rigidity, progressive distension, fever, hemodynamic instability, leucocytosis or evidence of free fluid in the peritoneal cavity in addition to free air, a surgical attitude must be strongly considered. 1 , 5 …”

Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report

“…Percutaneous endoscopic tube placement is a routine procedure to support patients who are unable to tolerate adequate oral intake [ 1 ]. Even though it is a safe and effective method allowing enteric nutritional support, it is associated with certain complications like any other procedure [ 2 ]. Percutaneous endoscopic jejunostomy (PEJ) is mainly used in cases of gastric pathology and gastric surgeries.…”