Marked pneumoperitoneum 3 weeks after percutaneous endoscopic gastrostomy

Area of Science:

• Gastroenterology
• Medical Devices
• Patient Safety

Background:

• A patient with dysphagia due to cerebral anoxia required long-term nutritional support via nasogastric tube feeding.
• Percutaneous endoscopic gastrostomy (PEG) was performed to improve nutritional status and quality of life.

Observation:

• Three weeks post-PEG, the patient developed wound infection and abdominal distension.
• Radiological examination confirmed marked pneumoperitoneum without signs of peritonitis.
• A gastrografin study confirmed appropriate PEG tube placement within the stomach.

Findings:

• Pneumoperitoneum resolved within 7 days after suspending tube feeding and decompressing the stomach.
• Tube feeding was successfully resumed after 40 days with no recurrence of pneumoperitoneum.
• The likely cause was insufficient PEG tube fixation leading to gastric wall air leakage.

Implications:

• Recommendations include maintaining a 1 cm gap for the external binder and periodic tube rotation to ensure proper fixation.
• Abdominal distension post-PEG warrants imaging (X-ray, CT) to rule out pneumoperitoneum.
• This case highlights the importance of meticulous PEG tube management to prevent and manage complications.