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Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report

Kalliopi Papakonstantinou1, Athanasios Karagiannis, Maria Tsirantonaki

  • 1Intensive Care Unit of Athens General Hospital, Athens, Greece. akarab@forthnet.gr

BMC Gastroenterology
|June 7, 2003
PubMed
Abstract

Insights

Percutaneous endoscopic gastrostomy (PEG) can lead to rare but serious complications like mediastinitis from esophageal perforation. Early diagnosis and surgical intervention are crucial for a favorable outcome in these critical cases.

Area of Science:

  • Gastroenterology
  • Surgical Endoscopy
  • Critical Care Medicine

Background:

  • Percutaneous endoscopic gastrostomy (PEG) is a widely adopted procedure for long-term enteral feeding.
  • While generally safe, PEG is associated with various complications, ranging from minor to severe.

Observation:

  • A case of masked esophageal perforation following PEG in a multi-traumatized patient is presented.
  • The patient developed mediastinitis and sepsis 10-14 days post-procedure, indicated by fever, sternal tenderness, and CT findings.
  • Surgical intervention included mediastinal drainage, gastrostomy removal, and jejunostomy placement.

Findings:

  • Perforating mediastinitis is a rare but life-threatening complication of PEG.
  • Prompt diagnosis and aggressive surgical management are essential for patient recovery.
  • This case highlights the potential for favorable outcomes even with severe complications.

Implications:

  • Clinicians should maintain a high index of suspicion for esophageal perforation in patients with delayed sepsis after PEG.
  • Timely surgical intervention can prevent mortality associated with post-PEG mediastinitis.
  • This case underscores the importance of comprehensive patient assessment and management in complex trauma scenarios involving PEG.

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