title: Peritonitis following percutaneous gastrostomy in children: management guidelines.
abstract: 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.
authors.affiliation: Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: C P
authors.initials: CP
authors.lastname: Kimber
authors.forename: I U
authors.initials: IU
authors.lastname: Khattak
authors.forename: E M
authors.initials: EM
authors.lastname: Kiely
authors.forename: L
authors.initials: L
authors.lastname: Spitz
mesh_terms: D002648:Child; D003108:Colonic Diseases / Q000209:etiology* / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology* / Q000601:surgery; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology*; D011027:Pneumoperitoneum / Q000209:etiology; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome