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Pyeloduodenal fistula: a previously undescribed complication of Stamm gastrostomy
J C Bleacher1, G B Boline, R M Decter
1Department of Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.
Insights
This study reports the first case of pyeloduodenal fistula following Stamm gastrostomy in an infant. Nonoperative management, including tube removal and nutritional support, proved successful.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Stamm gastrostomy is a common procedure in pediatric patients.
- Various complications have been associated with Stamm gastrostomy, but pyeloduodenal fistula is exceptionally rare.
Observation:
- A 4 1/2-month-old boy developed a pyeloduodenal fistula after Stamm gastrostomy placement.
- This represents the first documented case of this specific complication in pediatric literature.
Findings:
- The child was successfully treated with nonoperative therapy.
- Treatment involved Foley catheter removal from the renal pelvis, bowel rest, and total parenteral nutrition.
Implications:
- This case highlights a rare but serious complication of Stamm gastrostomy.
- Nonoperative management can be a viable option for pyeloduodenal fistula in pediatric patients.
- Understanding pathophysiological differences between adult and pediatric cases is crucial for effective treatment.
Abstract:
A variety of complications have been described after placement of a Stamm gastrostomy in infants and children, including gastric volvulus, pancreatitis, jaundice, gastroduodenal mucosal intussusception with gastric outlet obstruction, and even aortogastric fistula. However, this is the first report of pyeloduodenal fistula after Stamm gastrostomy in a 4 1/2-month-old boy. The child successfully underwent nonoperative therapy; he was treated by withdrawing the gastrostomy tube (Foley catheter) from the renal pelvis, bowel rest, and total parenteral nutrition. After the case presentation is a brief review of this rare entity, with its clinical presentation and pathophysiological differences between adult and pediatric cases. Various treatment options, both operative and nonoperative, are also described.