Downloaded from adc.bmj.com on October 4, 2014 - Published by group.bmj.com
Images in paediatrics
Complication of percutaneous endoscopic gastrostomy Gastrostomy feeding tubes are used in children to manage feeding difficulties of a variety of causes.1 Several methods for gastrostomy insertion are described, including percutaneous endoscopic gastrostomy (PEG),2 laparoscopic-assisted, radiological or open surgical placement. The PEG ‘pull’ technique is performed without intraperitoneal visualisation of the stomach puncture and so may be associated with injury to other organs, most commonly the colon.1 A 6-year-old girl with hypoplastic left heart syndrome was referred for removal of her Freka gastrostomy. This had been placed percutaneously 3 years earlier in another centre. Over the previous 18 months there had been persistent discharge and more recently trouble advancing and rotating the tube. At gastroscopy, neither the gastrostomy tube nor fistula could be seen, raising the possibility of ‘buried bumper’ syndrome, described in 2.5% of PEGs.3 The tube was cut, releasing a faeculent odour, so laparotomy was undertaken. The transverse colon was identified and was intact. The gastrostomy tube had previously
been inserted through the abdominal wall, via the anterior aspect of the liver and into the stomach. Freeing the stomach demonstrated that the retention bumper of the tube had migrated and was entirely buried within the liver. The device was dissected free from the liver using monopolar and argon diathermy. The patient recovered well and was discharged on postoperative day seven (figure 1). Transhepatic placement of PEGs is documented,4 but to our knowledge there are no paediatric reports of intrahepatic buried bumper. Stephen D Adams,1 David Baker,1 Arjun Takhar,2 R Mark Beattie,3 Michael P Stanton1 1
Department of Paediatric Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK 2 Department of Hepatobiliary Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK 3 Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK Correspondence to Mr Michael P Stanton, Department of Paediatric Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK; [email protected] Contributors SDA and DB wrote the main text and MPS reviewed and edited. AT and RMB contributed to review and comment as well as to the clinical care of the child. Competing interests None. Patient consent Obtained from the parents. Provenance and peer review Not commissioned; externally peer reviewed.
To cite Adams SD, Baker D, Takhar A, et al. Arch Dis Child 2014;99:788. Accepted 24 March 2014 Published Online First 15 April 2014 Arch Dis Child 2014;99:788. doi:10.1136/archdischild-2014-306123
REFERENCES 1 2 3
Figure 1 Intrahepatic buried bumper of a gastrostomy tube in a 6-year-old.
788
4
Fröhlich Tm, Richter M, Carbon R, et al. Review article: percutaneous endoscopic gastrostomy in infants and children. Aliment Pharmacol Ther 2010;31:788–801. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15:872–5. Vervloessem D, van Leersum F, Boer D, et al. Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications. Semin Pediatr Surg 2009;18:93–7. Gauderer MW. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg 1991;26:288–94.
Adams SD, et al. Arch Dis Child August 2014 Vol 99 No 8
Downloaded from adc.bmj.com on October 4, 2014 - Published by group.bmj.com
Complication of percutaneous endoscopic gastrostomy Stephen D Adams, David Baker, Arjun Takhar, et al. Arch Dis Child 2014 99: 788 originally published online April 15, 2014
doi: 10.1136/archdischild-2014-306123
Updated information and services can be found at: http://adc.bmj.com/content/99/8/788.full.html
These include:
References
This article cites 4 articles http://adc.bmj.com/content/99/8/788.full.html#ref-list-1
Email alerting service
Topic Collections
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Stomach and duodenum (42 articles) Competing interests (ethics) (126 articles) Congenital heart disease (103 articles) Endoscopy (17 articles) Journalology (172 articles) Physiotherapy (68 articles) Surgery (199 articles) Surgical diagnostic tests (191 articles)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to: http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Images in paediatrics
Complication of percutaneous endoscopic gastrostomy Gastrostomy feeding tubes are used in children to manage feeding difficulties of a variety of causes.1 Several methods for gastrostomy insertion are described, including percutaneous endoscopic gastrostomy (PEG),2 laparoscopic-assisted, radiological or open surgical placement. The PEG ‘pull’ technique is performed without intraperitoneal visualisation of the stomach puncture and so may be associated with injury to other organs, most commonly the colon.1 A 6-year-old girl with hypoplastic left heart syndrome was referred for removal of her Freka gastrostomy. This had been placed percutaneously 3 years earlier in another centre. Over the previous 18 months there had been persistent discharge and more recently trouble advancing and rotating the tube. At gastroscopy, neither the gastrostomy tube nor fistula could be seen, raising the possibility of ‘buried bumper’ syndrome, described in 2.5% of PEGs.3 The tube was cut, releasing a faeculent odour, so laparotomy was undertaken. The transverse colon was identified and was intact. The gastrostomy tube had previously
been inserted through the abdominal wall, via the anterior aspect of the liver and into the stomach. Freeing the stomach demonstrated that the retention bumper of the tube had migrated and was entirely buried within the liver. The device was dissected free from the liver using monopolar and argon diathermy. The patient recovered well and was discharged on postoperative day seven (figure 1). Transhepatic placement of PEGs is documented,4 but to our knowledge there are no paediatric reports of intrahepatic buried bumper. Stephen D Adams,1 David Baker,1 Arjun Takhar,2 R Mark Beattie,3 Michael P Stanton1 1
Department of Paediatric Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK 2 Department of Hepatobiliary Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK 3 Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK Correspondence to Mr Michael P Stanton, Department of Paediatric Surgery, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK; [email protected] Contributors SDA and DB wrote the main text and MPS reviewed and edited. AT and RMB contributed to review and comment as well as to the clinical care of the child. Competing interests None. Patient consent Obtained from the parents. Provenance and peer review Not commissioned; externally peer reviewed.
To cite Adams SD, Baker D, Takhar A, et al. Arch Dis Child 2014;99:788. Accepted 24 March 2014 Published Online First 15 April 2014 Arch Dis Child 2014;99:788. doi:10.1136/archdischild-2014-306123
REFERENCES 1 2 3
Figure 1 Intrahepatic buried bumper of a gastrostomy tube in a 6-year-old.
788
4
Fröhlich Tm, Richter M, Carbon R, et al. Review article: percutaneous endoscopic gastrostomy in infants and children. Aliment Pharmacol Ther 2010;31:788–801. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15:872–5. Vervloessem D, van Leersum F, Boer D, et al. Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications. Semin Pediatr Surg 2009;18:93–7. Gauderer MW. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg 1991;26:288–94.
Adams SD, et al. Arch Dis Child August 2014 Vol 99 No 8
Downloaded from adc.bmj.com on October 4, 2014 - Published by group.bmj.com
Complication of percutaneous endoscopic gastrostomy Stephen D Adams, David Baker, Arjun Takhar, et al. Arch Dis Child 2014 99: 788 originally published online April 15, 2014
doi: 10.1136/archdischild-2014-306123
Updated information and services can be found at: http://adc.bmj.com/content/99/8/788.full.html
These include:
References
This article cites 4 articles http://adc.bmj.com/content/99/8/788.full.html#ref-list-1
Email alerting service
Topic Collections
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Stomach and duodenum (42 articles) Competing interests (ethics) (126 articles) Congenital heart disease (103 articles) Endoscopy (17 articles) Journalology (172 articles) Physiotherapy (68 articles) Surgery (199 articles) Surgical diagnostic tests (191 articles)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to: http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to: http://group.bmj.com/subscribe/
