Peritonitis after gastrostomy tube replacement: a case series and review of literature.

BACKGROUND: The placement of feeding gastrostomy (G) tubes through a percutaneous endoscopic gastrostomy (PEG) technique has become common because of its simplicity and safety. The majority of the serious complications are reported to occur within a few days of initial tube placement and happen in fewer than 3% of cases. Long-term reported complications of this procedure include occlusion or breakage of the G-tube, requiring reinsertion. This report describes the complication of intraperitoneal placement and the development of peritonitis after replacement of an established PEG tube and reviews the pertinent world literature.

METHODS: A retrospective review of cases of intraperitoneal insertion of replacement G-tubes was done as well as a Medline search for cases of intraperitoneal insertion of replacement G-tube or development of peritonitis after replacement tube insertion.

RESULTS: Three new cases of inadvertent intraperitoneal insertion of a replacement G-tube in adult patients with mature tracts are reported. An additional 5 cases have been previously described in adults. Significant morbidity was associated with this complication, and 4 deaths were related to it. Methods used to determine whether the replacement G-tube was intragastric were not uniform.

CONCLUSIONS: There have been few reports of intraperitoneal insertion of replacement G-tubes in patients with mature (>30 days) stoma sites. The cases presented in this report highlight for the clinician the importance of considering this complication, particularly if there are any difficulties with the reinsertion. Prospective studies are needed to determine the frequency of this complication and the optimal protocol for PEG replacement.