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DOI: 10.1055/s-0030-1256077
© Georg Thieme Verlag KG Stuttgart · New York
Gastric rupture before puncture of the stomach in percutaneous gastrostomy
A. GotoMD, PhD
Department of Gastroenterology
Kushiro City General
Hospital
1-12, Shunkodai
Kushiro, 085-0822
Japan
Fax: +81-0154-414080
Email: goa@sapmed.ac.jp
Publication History
Publication Date:
01 February 2011 (online)
A 73-year-old man had swallowing difficulties because of a recent cerebrovascular accident, and was on enteral feeding via a nasogastric tube. Percutaneous endoscopic gastrostomy (PEG) was chosen for long-term enteral feeding. Before the PEG tube was inserted, a flexible endoscope was inserted into the stomach for inspection. No gross abnormal lesion was detected in the upper gastrointestinal tract ([Fig. 1]).
Then, before puncturing, the stomach was insufflated and indentation of the gastric lumen was confirmed by finger palpation of the abdominal wall. This caused the patient to choke a few times. Subsequently, bleeding occurred in the upper stomach. Several fusiform-shaped tears had developed along the lesser curvature of the proximal stomach ([Fig. 2]).
Computed tomography (CT) imaging revealed pneumoperitoneum ([Fig. 3 a]) and pneumomediastinum ([Fig. 3 b]), requiring emergency laparotomy.
A 2-cm-long full-thickness tear along the lesser curvature of the stomach close to the cardia was identified and sutured.
Gastric rupture is caused by increased gastric pressure resulting from increased intra-abdominal pressure, with or without overdistention caused by food or gas. In more than 70 % of the adult cases, gastric rupture occurs in the less distensible proximal lesser curvature of the stomach [1]. Spontaneous gastric rupture occurs due to vomiting, vigorous coughing, or convulsion. Its cause may also be iatrogenic, resulting from cardiopulmonary resuscitation, inadvertent esophageal intubation, Heimlich maneuver, or esophagogastroduodenoscopy (EGD) [1] [2] [3].
Diagnostic EGD is extremely safe, and perforation of the gastrointestinal tract is rare with an incidence of 0.001 % – 0.05 % [4]. Gastric rupture during gastric insufflations, which are performed before puncturing the stomach for a PEG, is also rarely reported [5]. Endoscopic gastric insufflation with air is important to avoid colon injury. In the present case, the patient’s choking during gastric insufflations, which led to a sudden increase in intra-abdominal pressure, may have caused the gastric rupture. Endoscopists should consider this rare yet potentially lethal complication.
Endoscopy_UCTN_Code_CPL_1AH_2AI
Competing interests: None
#References
- 1 Barker S J, Karagianes T. Gastric barotrauma: a case report and theoretical considerations. Anesth Analg. 1985; 64 1026-1028
- 2 Tung P H, Law S, Chu K M et al. Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation. Hepatogastroenterology. 2001; 48 109-111
- 3 Ho C M, Yin I W, Tsou K F et al. Gastric rupture after awake fibreoptic intubation in a patient with laryngeal carcinoma. Br J Anaesth. 2005; 94 856-858
- 4 Misra T, Lalor E, Fedorak R N. Endoscopic perforation rates at a Canadian university teaching hospital. Can J Gastroenterol. 2004; 18 221-226
- 5 Schrag S P, Sharma R, Jaik N P et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007; 16 407-418
A. GotoMD, PhD
Department of Gastroenterology
Kushiro City General
Hospital
1-12, Shunkodai
Kushiro, 085-0822
Japan
Fax: +81-0154-414080
Email: goa@sapmed.ac.jp
References
- 1 Barker S J, Karagianes T. Gastric barotrauma: a case report and theoretical considerations. Anesth Analg. 1985; 64 1026-1028
- 2 Tung P H, Law S, Chu K M et al. Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation. Hepatogastroenterology. 2001; 48 109-111
- 3 Ho C M, Yin I W, Tsou K F et al. Gastric rupture after awake fibreoptic intubation in a patient with laryngeal carcinoma. Br J Anaesth. 2005; 94 856-858
- 4 Misra T, Lalor E, Fedorak R N. Endoscopic perforation rates at a Canadian university teaching hospital. Can J Gastroenterol. 2004; 18 221-226
- 5 Schrag S P, Sharma R, Jaik N P et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007; 16 407-418
A. GotoMD, PhD
Department of Gastroenterology
Kushiro City General
Hospital
1-12, Shunkodai
Kushiro, 085-0822
Japan
Fax: +81-0154-414080
Email: goa@sapmed.ac.jp