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Melek J, Štanclová M, Štichhauer R, Rozsíval P, Kopřiva J, Dědková J, Terifajova E, Šedivá E, Dědek P, Skálová S, Bureš J. Duodenal Pressure Necrosis in a Child Caused by a Migrated Percutaneous Endoscopic Gastrostomy. Acta Medica (Hradec Kralove) 2021; 63:79-81. [PMID: 32771073 DOI: 10.14712/18059694.2020.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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 children which cannot be treated without invasive procedures.
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Affiliation(s)
- Jan Melek
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic.
| | - Markéta Štanclová
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Radek Štichhauer
- Department of Pediatric Surgery and Traumatology, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Pavel Rozsíval
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Jan Kopřiva
- Department of Radiology, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Jana Dědková
- Department of Radiology, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Eva Terifajova
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Eva Šedivá
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Petr Dědek
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Sylva Skálová
- Department of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
| | - Jan Bureš
- 2nd Department of Internal Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
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