Duodenal Pressure Necrosis in a Child Caused by a Migrated Percutaneous Endoscopic Gastrostomy

Melek, Jan; Štanclová, Markéta; Štichhauer, Radek; Rozsíval, Pavel; Kopřiva, Jan; Dědková, Jana; Terifajova, Eva; Šedivá, Eva; Dědek, Petr; Skálová, Sylva; Bureš, Jan

doi:10.14712/18059694.2020.21

Acta Medica > Archive > 2020, Vol. 63 > Issue 2 > Duodenal Pressure Necrosis in a Child…

Acta Med. 2020, 63: 79-81

https://doi.org/10.14712/18059694.2020.21

Duodenal Pressure Necrosis in a Child Caused by a Migrated Percutaneous Endoscopic Gastrostomy

Jan Melek^a

, Markéta Štanclová^a, Radek Štichhauer^b

, Pavel Rozsíval^a, Jan Kopřiva^c, Jana Dědková^c, Eva Terifajova^a, Eva Šedivá^a, Petr Dědek^a, Sylva Skálová^a, Jan Bureš^d

^aDepartment of Pediatrics, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
^bDepartment of Pediatric Surgery and Traumatology, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
^cDepartment of Radiology, Charles University, Faculty of Medicine in Hradec Králové; University Hospital Hradec Králové, Czech Republic
^d2nd Department of Internal Medicine – Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic

Received January 24, 2020
Accepted May 7, 2020

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.