PERITONITIS FOLLOWING PERCUTANEOUS GASTROSTOMY IN CHILDREN - MANAGEMENT GUIDELINES

Background: To establish the incidence, timing and outcome of peritoni tis following percutaneous gastrostomy (PEG) insertion in children. Me thods: Patients developing peritonitis after PEG insertion during a 5- year period (1990-95) were identified. Variables analysed included cli nical presentation, management, operative findings and outcome. Result s: One hundred and twenty paediatric patients received 130 PEG in the 5-year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3-18 months lat er). All four patients developing early peritonitis underwent laparoto my in whom three had sustained major damage to adjacent viscera. The f ourth patient had a negative laparotomy, but died from continued overw helming sepsis. All four patients who developed peritonitis after a ro utine tube change underwent a tube contrast study. In two children a g astrocolic Fistula was identified and surgically repaired. Contrast st udies in two patients detected an intraperitoneal leak. This problem r esolved with conservative management in both cases. Conclusions: Perit onitis immediately following PEG insertion is rarely due to the air le akage during insertion (benign pneumo peritoneum) and warrants early l aparotomy to identify and correct the likely associated visceral traum a. Following PEG tube change peritonitis may result from stomal separa tion or tube malposition and an urgent study is indicated to identify the cause.