Intestinal Research

Original Articles

Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy: Won Young Park, Tae Hee Lee, Joon Seong Lee, Su Jin Hong, Seong Ran Jeon, Hyun Gun Kim, Joo Young Cho, Jin Oh Kim, Jun Hyung Cho, Sang Wook Lee, Young Kwan Cho; Intest Res 2015;13(4):313-317. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.313

<b>Background/Aims</b><br/>

Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG.

Methods

We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion.

Results

Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock.

Conclusions

The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.

Citations

Citations to this article as recorded by

Behind the Ink: Unmasking Asymptomatic Micro-perforations Following Endoscopic Tattooing
Woo Suk Kim, Tasur Seen, Joel Baum, Aaron Walfish
Cureus.2025;[Epub] CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Endoscopic Complications Are More Frequent in Levodopa–Carbidopa Intestinal Gel Treatment via JET-PEG in Parkinson’s Disease Patients Compared to Nutritional PEG in Non-Parkinson’s Disease Patients
Laura Gombošová, Jana Deptová, Ivana Jochmanová, Tatiana Svoreňová, Eduard Veseliny, Mária Zakuciová, Vladimír Haň, Alexandra Lacková, Kristína Kulcsárová, Miriama Ostrožovičová, Joaquim Ribeiro Ventosa, Lenka Trcková, Ivica Lazúrová, Matej Škorvánek
Journal of Clinical Medicine.2024; 13(3): 703. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report
Khalid Al Shamousi, Masoud Salim Kashoob, Jawahir Lal, Said A Al-Busafi
Cureus.2023;[Epub] CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Incidence of Pneumoperitoneum After Gastrostomy Tube Removal
Anas Mahmoud, Nizar Alyassin, Eyad Baghal, Ruhin Yuridullah, Yana Cavanagh, Matthew A Grossman
Cureus.2023;[Epub] CrossRef
Prevention and management of major complications in percutaneous endoscopic gastrostomy
Kurt Boeykens, Ivo Duysburgh
BMJ Open Gastroenterology.2021; 8(1): e000628. CrossRef
Massive Incidental Pneumoperitoneum in an Amyotrophic Lateral Sclerosis Patient
Jasmin Jaber, Nur Magadle, Lojain Arda, Francisco J Somoza-Cano
Cureus.2021;[Epub] CrossRef
Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue
Jahnvi Dhar, Naveen Kumar, Pankaj Gupta, Rakesh Kochhar, Jayanta Samanta
Journal of Digestive Endoscopy.2021; 12(03): 169. CrossRef
Symptomatic Pneumoperitoneum After Gastrostomy Tube Placement Managed by Pneumocentesis
Tim Brotherton, Anuj Chhaparia, Michael Presti, Gregory Sayuk, Jill Elwing
ACG Case Reports Journal.2021; 8(11): e00700. CrossRef
TWO APPROACHES TO PNEUMOPERITONEUM: SURGERY AND CONSERVATIVE
Şehmus Ölmez, Bünyamin Sarıtaş, Mesut Aydın, Banu Kara
Gastroenterology Nursing.2020; 43(4): 317. CrossRef
Diagnosis and treatment of pediatric benign pneumoperitoneum
Shou-Xing Duan, Zong-Bo Sun, Guang-Huan Wang, Jun Zhong, Wen-Hui Ou, Ma-Xian Fu, Fu-Sheng Wang, Shu-Hua Ma, Jian-Hong Li
Medicine.2017; 96(2): e5814. CrossRef
Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis
Joo Hyun Lim, Seung Ho Choi, Changhyun Lee, Ji Yeon Seo, Hae Yeon Kang, Jong In Yang, Su Jin Chung, Joo Sung Kim
Intestinal Research.2016; 14(4): 333. CrossRef
The role of surgery in the treatment of endoscopic complications
Peter Dixon, Gopal C. Kowdley, Steven Clark Cunningham
Best Practice & Research Clinical Gastroenterology.2016; 30(5): 841. CrossRef
Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy: Does It Have Clinical Significance?
Ju Yup Lee, Kyung Sik Park
Intestinal Research.2015; 13(4): 295. CrossRef

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Efficacy of Infliximab Rescue Therapy in Hospitalized Patients with Steroid-Refractory Ulcerative Colitis: Single Center Experience: Jun Hyung Cho, Chang Kyun Lee, Hyo Jong Kim, Jae Jun Shim, Jae Young Jang, Seok Ho Dong, Byung Ho Kim, Young Woon Chang; Intest Res 2012;10(2):152-160. Published online April 30, 2012; DOI: https://doi.org/10.5217/ir.2012.10.2.152

Abstract PDF

Background/Aims
In hospitalized patients with acute steroid-refractory UC, infliximab has been demonstrated to be one of the medical rescue therapies to avoid colectomy. We report the result of a retrospective observational study to find the efficacy and safety of infliximab as a rescue therapy in our hospital. Methods: Between January 2007 and January 2010, 9 hospitalized patients with steroid-refractory UC were selected to receive three infusions of infliximab (5 mg/kg), at weeks 0, 2, and 6. Efficacy of treatment was evaluated at 8 weeks after the first infliximab infusion and at the end of follow-up period. Adverse events related to infliximab rescue therapy were also collected. Results: Seven patients (77.8%) had completed 3 infusions of infliximab and achieved clinical response at 8 weeks after the first infliximab infusion. Clinical remission rate and the rate of mucosal healing at 8 weeks were 57.1% (4/7) and 71.4% (5/7), respectively. They were followed up for median time of 24.9 months (19.5-53.6 months). One patient underwent emergency colectomy at weeks 2, due to colon perforation, while another patient had discontinued infliximab treatment at weeks 4, because of Clostridium difficile-associated colitis. Finally, colectomy was avoided in 77.8% (7/9) of cases. There was no mortality. Conclusions: Rescue therapy with infliximab has sustained clinical benefit in 88.9% of our hospitalized patients with acute steroid-refractory UC. Future prospective and long-term follow-up trials with a large number of patients are needed to confirm the efficacy and safety of the treatment. (Intest Res 2012;10: 0-160)

Citations

Citations to this article as recorded by

Differences in the Prognosis according to the Periods of Diagnosis in Ulcerative Colitis
Hyun Beom Chae, Yoon Suk Jung, Dong Il Park, Chang Kyun Lee, Kyu Chan Huh, Jeong Eun Shin, Jae Hak Kim, You Sun Kim, Yunho Jung, Sung Ae Jung, Hyun Ju Song, Hyun Joo Jang, Sung Noh Hong, Young-Ho Kim
The Korean Journal of Gastroenterology.2014; 64(2): 93. CrossRef

3,062 View
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