Tension Pneumoperitoneum as a Late Complication of Surgical Gastrostomy

Laparoendoscopic Evaluation and Treatment of Massive Pneumoperitoneum Occurring 1 Year After Gastrostomy Tube Removal

“…The mechanism whereby this occurred is not clear, but other case reports have implicated blunt abdominal trauma or severe emesis. 15,28,29 In this patient, the most likely explanation is that persistent hiccups caused a small tear where the stomach was tethered to the anterior abdominal wall. The patient was spared florid peritonitis because acidic gastric contents did not evacuate through this nondependent small tear; a 1-way valve effect resulted in the development of tense pneumoperitoneum.…”

“…15,28,29 Though pneumoperitoneum after PEG placement has been frequently reported in the surgical literature, the occurrence seems temporally related to device placement (even up to weeks after PEG insertion). This patient developed pneumoperitoneum 1 year after the removal of his gastrostomy tube.…”

“…The significance and timing of this finding has prompted numerous studies and case reports over the past 2 decades. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] We report an interesting case of massive pneumoperitoneum associated with a previous PEG tube site.…”