Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy.
Percutaneous gastrostomy (PG) with gastropexy was performed for relief of malignant small bowel obstruction in 12 patients with extensive ascites. Abdominal paracentesis was performed before PG in nine patients and after PG in one patient. Gastrostomy catheters were inserted without complication in all patients. Clinical follow up revealed that pericatheter leakage of ascitic fluid and skin excoriation occurred only in the three patients who did not have paracentesis performed before PG. No dislodgement of gastrostomy catheters occurred but mild peritonitis was noted in one patient. Our experience suggests that although in the past extensive ascites was a relative contraindication for PG, these patients can now be successfully treated with a combination of ultrasound-guided paracentesis to reduce pericatheter leakage of ascitic fluid, and gastropexy to prevent catheter dislodgement.
Lee
M J
MJ
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Saini
S
S
Brink
J A
JA
Morrison
M C
MC
Hahn
P F
PF
Mueller
P R
PR
D000005:Abdomen / Q000000981:diagnostic imaging; D000009:Abdominal Muscles / Q000601:surgery; D000368:Aged; D001201:Ascites / Q000601:surgery*; D001202:Ascitic Fluid / Q000601:surgery; D000075202:Contraindications; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000150:complications; D014594:Uterine Neoplasms / Q000150:complications