Intest Res.  2015 Oct;13(4):313-317. 10.5217/ir.2015.13.4.313.

Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy

• Park WY
• Lee TH
• Lee JS
• Hong SJ
• Jeon SR
• Kim HG
• Cho JY
• Kim JO
• Cho JH
• Lee SW
• Cho YK

• KMID: 2070746
• DOI: http://doi.org/10.5217/ir.2015.13.4.313

Abstract

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.

Keyword

Endoscopy, gastrointestinal; Pneumoperitoneum; Gastrostomy

MeSH Terms

Anti-Bacterial Agents
Diaphragm
Endoscopy, Gastrointestinal
Fever
Follow-Up Studies
Gastrostomy*
Humans
Leukocytosis
Pneumonia
Pneumoperitoneum*
Retrospective Studies
Shock, Septic
Thorax
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Pneumoperitoneum grades following percutaneous endoscopic gastrostomy. (A) Small grade of pneumoperitoneum is defined when the height of the air column under the diaphragm is less than 2 cm. (B) Moderate grade of pneumoperitoneum is defined when the height of the air column under the diaphragm ranges from 2 to 4 cm. (C) Large grade of pneumoperitoneum is defined when the height of the air column under the diaphragm ranges is more than 4 cm.

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