Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report

BMC Gastroenterology

Andreas Karabinis¹  Ion Skottis²  Spiros Spirou¹  Anastasios Konstantinidis³  Maria Tsirantonaki¹  Athanasios Karagiannis¹  Kalliopi Papakonstantinou¹ 

[1]Intensive Care Unit of Athens General Hospital, Athens, Greece

[2]First Thoracic Surgery Department of Athens Chest Diseases Hospital "Sotiria", Athens, Greece

[3]Endoscopic Department of Athens General Hospital, Athens, Greece

关键词: brain injury;    intensive care unit;    complications;    percutaneous endoscopic gastrostomy;    Mediastinitis;   

Others  :  1215891
DOI  :  10.1186/1471-230X-3-11

 received in 2003-04-08, accepted in 2003-06-06,  发布年份 2003

【 摘 要 】

Background

Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications.

Case presentation

A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten – fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit.

Conclusion

Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome.

【 授权许可】

   
2003 Papakonstantinou et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Gauderer MWL, Ponsky JL, Izant RJ Jr: Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Pediatr Surg 1980, 15:872-5.
• [2]American Society for Gastrointestinal Endoscopy: Role of PEG/PEJ in enteral feeding. Gastrointest Endosc 1998, 48:699-701.
• [3]Stellato TA, Gauderer MWL: PEG for Gastrointestinal Decompression. Ann Surg 1987, 205:119-22.
• [4]Larson DE, Burton DD, Schroeder KW, DiMagno EP: Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987, 93:48-52.
• [5]Grant JP: Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up. Ann Surg 1993, 217:168-174.
• [6]Panos MZ, Reilly H, Moran A, Reilly T, Wallis PJW, Wears R, Chesner IM: Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. Gut 1994, 35:1551-1556.
• [7]Beaslay SW, Catto-Smith AG, Davidson PM: How to avoid complication during percutaneous endoscopic gastrostomy. J Pediatr Surg 1995, 30:671-3.
• [8]Gottfried EB, Plumiser AB, Clair MR: Pneumoperitoneum following percutaneous endoscopic gastrostomy. Gastrointest Endosc 1986, 32:397-9.
• [9]Peteren TI, Kruse A: Complications of percutaneous endoscopic gastrostomy. Eur J Surg 1997, 163:351-356.
• [10]Lau G, Lai SH: Fatal retroperitoneal haemorrhage: an unusual complication of percutaneous endoscopic gastrostomy. Forensic Sci Int 2001, 116:69-75.
• [11]Robinson SR, Johnston P, Wyeth JW: Aortic perforation due to an impacted percutaneous endoscopic gastrostomy gastric flange. Aust N Z J Surg 2001, 71:71-2.
• [12]Kimber CP, Khattak IU, Kiely EM, Spitz L: Peritonitis following percutaneous gastrostomy in children: management guidelines. Aust N Z J Surg 1998, 68:268-70.
• [13]Yamazaki T, Sakai Y, Hatakeyama K, Hoshiyama Y: Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach. Surg Endosc 1999, 13(3):280-2.
• [14]Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F: Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997, 13:520-3.
• [15]Korula J, Rice HE: Necrotizing fasciitis and percutaneous endoscopic gastrostomy. Gastrointest Endosc 1987, 33:335-6.
• [16]Hull MA, Rawlings J, Murray FE, Field J, McIntyre AS, Mahida YR, Hawkey CJ, Allison SP: Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 1993, 341:869-872.
• [17]Patel B, Fares J, Green J, Spira R: Endoscopic retrieval of a dislodged PEG tube from the terminal ileum [abstract]. Am J Gastroenterol 2001, S232:AB741.
• [18]Moran BJ, Taylor MB, Jonson CD: Percutaneous endoscopic gastrostomy. Br J Surg 1990, 77:858-862.
• [19]Kadakia SC, Sullivan HO, Starnes E: Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients. Am J Surg 1992, 164:114-8.
• [20]Abuksis G, Mor M, Segal N, Shemesh I, Plout S, Sulkes J, Fraser GM, Niv Y: Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 2000, 95:128-32.