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Peritonitis following percutaneous gastrostomy in children: management guidelines
C P Kimber1, I U Khattak, E M Kiely
1Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
Insights
Peritonitis after pediatric percutaneous gastrostomy (PEG) insertion can occur early, often due to visceral trauma requiring surgery, or later, typically from tube issues managed with contrast studies and sometimes repair.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastrointestinal Endoscopy
Background:
- Percutaneous gastrostomy (PEG) is a common procedure in pediatric patients.
- Peritonitis is a potential complication following PEG insertion and tube manipulation.
- Understanding the incidence, timing, and outcomes of peritonitis is crucial for patient management.
Purpose of the Study:
- To determine the incidence and timing of peritonitis after PEG insertion in children.
- To analyze the clinical presentation, management strategies, and outcomes of pediatric peritonitis post-PEG.
- To differentiate causes and appropriate interventions for early-onset versus late-onset peritonitis.
Main Methods:
- A retrospective analysis of pediatric patients who underwent PEG insertion between 1990 and 1995.
- Identification of patients who developed peritonitis following PEG insertion or tube change.
- Review of clinical data including presentation, management, operative findings, and patient outcomes.
Main Results:
- Eight out of 120 pediatric patients (receiving 130 PEGs) developed peritonitis.
- Four cases occurred within 24 hours of PEG insertion, often associated with visceral trauma requiring laparotomy.
- Four cases occurred 3-18 months post-insertion, linked to tube changes, with gastrocolic fistulas or intraperitoneal leaks identified via contrast studies.
Conclusions:
- Early peritonitis post-PEG insertion is uncommon and usually indicates visceral trauma necessitating prompt laparotomy.
- Late peritonitis after routine PEG tube changes may stem from stomal separation or malposition, requiring urgent contrast studies.
- Timely diagnosis and appropriate intervention, surgical or conservative, are key to managing peritonitis following pediatric PEG procedures.
Background:
To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children.
Methods:
Patients developing peritonitis after PEG insertion during a 5-year period (1990-95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome.
Results:
One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3-18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases.
Conclusions:
Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.