Pneumo-peritoneum following PEG insertion: a clinical dilemma

Area of Science:

• Gastroenterology
• Surgical Complications
• Diagnostic Imaging

Background:

• Multiple sclerosis patients may require percutanous endoscopic gastrostomy (PEG) tubes for nutritional support.
• Post-procedural complications following PEG insertion require careful evaluation.
• Pneumoperitoneum, or gas in the abdominal cavity, can occur after various abdominal procedures.

Purpose of the Study:

• To present a case of a patient with multiple sclerosis experiencing symptoms after PEG tube insertion.
• To discuss the differential diagnosis of pneumoperitoneum following PEG placement.
• To emphasize the importance of appropriate imaging prior to surgical intervention.

Main Methods:

• Case report of a 48-year-old male with multiple sclerosis.
• Clinical presentation including fever, abdominal pain, and chest X-ray findings.
• Surgical exploration (laparotomy) to investigate intra-abdominal pathology.

Main Results:

• Chest X-ray revealed gas under the diaphragm post-PEG insertion.
• Laparotomy found no evidence of intra-abdominal sepsis.
• The patient's symptoms were attributed to benign pneumoperitoneum.

Conclusions:

• Benign pneumoperitoneum is a potential complication of PEG tube insertion that mimics surgical emergencies.
• Advanced imaging, such as CT scans, is crucial for accurate diagnosis when uncertainty exists.
• Avoidance of unnecessary laparotomy is important in managing post-PEG complications.