title: The incidence and clinical significance of pneumoperitoneum after percutaneous endoscopic gastrostomy: a review of 722 cases.
abstract: Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice for establishing enteral access in patients unable to take oral feedings. Serious complications are rare; however, misplaced PEGs and PEG/Jejunums can lead to hollow viscus injuries with intra-abdominal contamination and subsequent peritonitis, septicemia, and death. The presence of free intra-abdominal air is a reliable indicator of a perforated viscus and often points to a surgical emergency; however, in the case of PEGs, pneumoperitoneum without a perforated viscus, or "benign pneumoperitoneum" creates a diagnostic dilemma. To determine the incidence and clinical significance of pneumoperitoneum after PEG or PEG/Jejunum (J) we reviewed the records of 722 patients who underwent these procedures at our institution. Of 39 patients found to have free air after PEG/PEG/J placement, 33 (85%) had "benign pneumoperitoneum" and were discharged without complication or surgical intervention. Of the six patients with serious complications related to their procedure, five (83%) had clinical signs of intra-abdominal complications (peritonitis) that helped guide their management. Of these six patients, the two receiving abdominal radiographs instead of abdominal CT scanning had a 50 per cent negative laparotomy rate. We present an algorithm for the management of patients found to have pneumoperitoneum after PEG or PEG/J placement.
authors.affiliation: Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA. blum@musc.edu
authors.forename: Craig A
authors.initials: CA
authors.lastname: Blum
authors.forename: Craig
authors.initials: C
authors.lastname: Selander
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Ruddy
authors.forename: Stuart
authors.initials: S
authors.lastname: Leon
mesh_terms: D000328:Adult; D000465:Algorithms; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult