title: Pneumoperitoneum after percutaneous endoscopic gastrostomy among adults in the intensive care unit: incidence, predictive factors, and clinical significance.
abstract: The significance of post percutaneous endoscopic gastrostomy (PEG) pneumoperitoneum (PNP) is unclear. We studied patients in our intensive car unit who underwent PEG placement to better understand the significance of post PEG PNP at our institution. We identified all intensive care  unit patients who underwent PEG placement between the years of 2000 and 2009. A review of 318 consecutive PEG procedures was performed. Radiographic imaging was reviewed for up to 14 days post PEG, noting the presence of PNP. The presence of common comorbidities and PEG-related complications  were recorded. Of the 318 patients, radiologic imaging was not taken within 14 days in 37 patients. Forty-five patients were found to have PNP on imaging for an incidence of 16 per cent (45/281). Eight patients were found to require either surgical or endoscopic emergent intervention post  PEG. Four of these had PNP on imaging. Post PEG PNP was associated with increased likelihood for complications requiring emergent surgical intervention (P = 0.0078) and 30-day mortality post PEG insertion (P = 0.0216). The presence of common comorbid conditions was not a significant  determinant of post PEG PNP.
authors.affiliation: Saint Agnes Hospital, Department of Surgery, Baltimore, Maryland 21229, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Nazarian
authors.forename: Wirt
authors.initials: W
authors.lastname: Cross
authors.forename: Gopal Chandru
authors.initials: GC
authors.lastname: Kowdley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult