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KMID : 0988920150130040313
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Intestinal Research
2015 Volume.13 No. 4 p.313 ~ p.317
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Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy
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Park Won-Young
Lee Tae-Hee
Lee Joon-Seong
Hong Su-Jin
Jeon Seong-Ran
Kim Hyun-Gun
Cho Joo-Young
Kim Jin-Oh
Cho Jun-Hyung
Lee Sang-Wook
Cho Young-Kwan
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Abstract
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Background/Aims: Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG.
Methods: We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion.
Results: Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock.
Conclusions: The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.
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KEYWORD
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Endoscopy, gastrointestinal, Pneumoperitoneum, Gastrostomy
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