Duodenal Pressure Necrosis in a Child Caused by a Migrated Percutaneous Endoscopic Gastrostomy.

Duodenal Pressure Necrosis in a Child Caused by a Migrated Percutaneous Endoscopic Gastrostomy. Acta Medica (Hradec Kralove). 2020;63(2):79-81 Authors: Melek J, Štanclová M, Štichhauer R, Rozsíval P, Kopřiva J, Dědková J, Terifajova E, Šedivá E, Dědek P, Skálová S, Bureš J Abstract A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in ch...
Source: Acta Medica: Hradec Kralove - Category: General Medicine Tags: Acta Medica (Hradec Kralove) Source Type: research