Pneumoperitoneum post-fluoroscopic percutaneous gastrojejunostomy insertion: computed tomography and clinical...

Area of Science:

• Radiology
• Gastroenterology
• Interventional Radiology

Background:

• Pneumoperitoneum, the presence of air in the abdominal cavity, can occur after various abdominal procedures.
• Percutaneous gastrojejunostomy (PGJ) tube insertion is an imaging-guided procedure used for enteral nutrition.
• The clinical significance of pneumoperitoneum following PGJ insertion requires assessment.

Purpose of the Study:

• To determine the incidence of pneumoperitoneum after radiologic percutaneous gastrojejunostomy (PGJ) tube insertion.
• To evaluate the clinical significance of pneumoperitoneum in relation to specific signs and symptoms.
• To guide management strategies for post-PGJ pneumoperitoneum.

Main Methods:

• Prospective assessment of 16 subjects undergoing imaging-guided PGJ tube insertion.
• Immediate post-procedure computed tomography (CT) of the abdomen and pelvis to detect pneumoperitoneum.
• Clinical evaluation including physical examination, laboratory tests, and symptom assessment on days 1, 3, and 7 post-insertion.

Main Results:

• Pneumoperitoneum was detected in 15 out of 16 subjects (93.75%) following PGJ tube insertion.
• A small volume of pneumoperitoneum was observed in 10 subjects, while a large volume was seen in 2 subjects.
• The only consistently altered clinical findings were elevated white blood cell count and fever, primarily observed shortly after feeding tube placement.

Conclusions:

• Pneumoperitoneum is a frequent finding after percutaneous gastrojejunostomy tube placement.
• No statistically significant abnormal clinical parameters were associated with the presence or absence of pneumoperitoneum.
• Conservative management is recommended for pneumoperitoneum detected after PGJ tube insertion.