title: Peritonitis following percutaneous gastrostomy tube insertions in children.
abstract: BACKGROUND
  Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children.
  
  
  OBJECTIVE
  To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy.
  
  
  METHODS
  We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected.
  
  
  RESULTS
  Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor.
  
  
  CONCLUSIONS
  Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome. Patients with peritonitis are delayed starting feeds and have a hospital stay that is an average of 5 days longer than those without.
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada. Leema.dookhoo@mail.utoronto.ca.|University of Toronto, Faculty of Medicine, 1 Kings College Circle #3172, Toronto, ON, M5S 1A8, Canada. Leema.dookhoo@mail.utoronto.ca.
authors.forename: Leema
authors.initials: L
authors.lastname: Dookhoo
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Parra
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Philip R
authors.initials: PR
authors.lastname: John
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Joao G
authors.initials: JG
authors.lastname: Amaral
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010538:Peritonitis / Q000209:etiology*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Children; Gastrostomy; Interventional radiology; Peritonitis; Stomach