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Peritonitis following percutaneous gastrostomy tube insertions in children
Leema Dookhoo1,2, Sanjay Mahant3, Dimitri A Parra4
1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada. Leema.dookhoo@mail.utoronto.ca.
Insights
Peritonitis affects 2.5% of children after percutaneous retrograde gastrostomy, with no identified risk factors. Medical management is typically effective, though it delays feeding and prolongs hospital stays.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Percutaneous retrograde gastrostomy (PRG) is a successful pediatric procedure with low morbidity.
- Major complications, including peritonitis, can occur despite the procedure's safety profile.
- Limited research exists on peritonitis following PRG in children.
Purpose of the Study:
- Identify risk factors for peritonitis after PRG in children.
- Determine variables influencing the development and early diagnosis of post-PRG peritonitis.
Main Methods:
- Retrospective case-control study (2003-2012) of 1,504 pediatric patients undergoing PRG.
- Matched patients who developed peritonitis (group 1) with those who did not (group 2).
- Collected demographic, clinical, procedural, management, and outcome data.
Main Results:
- Peritonitis occurred in 2.5% of pediatric PRG cases within 7 days.
- Common symptoms included fever (89%), irritability (63%), and abdominal pain (55%).
- No specific risk factors (age, gender, weight, diagnosis, operator) were identified.
Conclusions:
- Peritonitis is an uncommon complication of pediatric PRG, occurring in approximately 2.5% of cases.
- Medical management is generally sufficient for favorable outcomes.
- Peritonitis leads to delayed enteral feeding and an extended hospital stay by an average of 5 days.
Background:
Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children.
Objective:
To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy.
Materials And Methods:
We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected.
Results:
Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor.
Conclusion:
Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome. Patients with peritonitis are delayed starting feeds and have a hospital stay that is an average of 5 days longer than those without.
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