Gastrostomy tube leak in a patient receiving peritoneal dialysis

Aggressive nutritional support is imperative to ensure an optimal quality of life in the management of children with end stage renal disease (ESRD). Supplemental enteral feeds using a gastrostomy tube (G-tube) are commonly used for nutritional support to overcome the barrier posed by anorexia. Some of the reported complications of G-tube feeds in children simultaneously receiving peritoneal dialysis include G-tube exit site infection with concomitant peritonitis and G-tube obstruction. We are reporting our experience in managing an 8-year-old Caucasian male with ESRD who, while receiving peritoneal dialysis and G-tube feeds, developed medically intractable peritonitis due to separation of the stomach wall from the anterior abdominal wall, resulting in peritoneal contamination with gastric contents. This complication, which has not previously been reported in patients receiving peritoneal dialysis, had devastating consequences, culminating in the death of our patient.