title: Early pneumoperitoneum after percutaneous endoscopic gastrostomy in intensive care patients: sign of possible bowel injury.
abstract: BACKGROUND
  Although percutaneous endoscopic gastrostomy may be complicated by iatrogenic bowel injury, most clinicians consider a small pneumoperitoneum on radiographs obtained after the procedure a benign finding of little clinical consequence. The possibility of a relationship between findings of early pneumoperitoneum after percutaneous endoscopic gastrostomy and subsequent iatrogenic bowel injury was examined.
  
  
  METHODS
  Charts of 85 patients in a surgical intensive care unit who had undergone percutaneous endoscopic gastrostomy between 2000 and 2005 were retrospectively reviewed. All patients had a follow-up upright chest radiograph obtained after percutaneous endoscopic gastrostomy. The charts of 4 patients with radiographs that showed early pneumoperitoneum were reviewed.
  
  
  RESULTS
  Findings were clinically significant in 1 of the 4 patients. That patient had a perforated transverse colon that required surgical repair. The other 3 patients had no complications.
  
  
  CONCLUSIONS
  Pneumoperitoneum after percutaneous endoscopic gastrostomy may be a sign of possible bowel injury and requires further evaluation. It should not be dismissed as benign. Obtaining a chest radiograph after a patient has undergone percutaneous endoscopic gastrostomy is essential.
authors.affiliation: The Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Milanchi
authors.forename: Alexander
authors.initials: A
authors.lastname: Allins
mesh_terms: D003106:Colon / Q000293:injuries*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology*; D013902:Radiography, Thoracic; D012189:Retrospective Studies