Abstract:
BACKGROUND:Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. OBJECTIVE:To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. MATERIALS AND METHODS:We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. RESULTS:Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. CONCLUSION:Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome. Patients with peritonitis are delayed starting feeds and have a hospital stay that is an average of 5 days longer than those without.
journal_name
Pediatr Radioljournal_title
Pediatric radiologyauthors
Dookhoo L,Mahant S,Parra DA,John PR,Amaral JG,Connolly BLdoi
10.1007/s00247-016-3628-5subject
Has Abstractpub_date
2016-09-01 00:00:00pages
1444-50issue
10eissn
0301-0449issn
1432-1998pii
10.1007/s00247-016-3628-5journal_volume
46pub_type
杂志文章abstract::ACTH is used in childhood to treat infantile spasms and acute cerebellar encephalopathy (opsoclonus-cerebellar ataxia syndrome). We report two infants with ultrasonographic and CT evidence of massive, reversible adrenal enlargement secondary to exogenous ACTH therapy for these disorders. ...
journal_title:Pediatric radiology
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pub_type: 临床试验,杂志文章,随机对照试验
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