Percutaneous Endoscopic Gastrostomy for Gastric Decompression After Repeated Intestinal Obstruction After Open Abdominal Surgery

Abstract

In patients with repeated intestinal obstructions after open abdominal surgery, aerophagia associated with disturbances in gastrointestinal passage causes the accumulation of large amounts of air, resulting in chronic symptoms including abdominal pain and distention and consequently malnutrition. We successfully used percutaneous endoscopic gastrostomy (PEG) for long-term gastric decompression in 2 cases with aerophagia. The first case was a 69-year-old Japanese man admitted for repeated intestinal obstruction after an appendectomy. After the last surgery for intestinal obstruction, the patient experienced repeated abdominal distention and anorexia, resulting in weight loss and malnutrition. The second case was a 79-year-old man complaining of abdominal pain and distention. He had a history of resection of the lower pharynx and larynx owing to total laryngectomy and had received a permanent tracheostomy. He then underwent surgery for intestinal obstruction. Because the patients' abdominal symptoms were unresponsive to administration of a peristalsis stimulant and a laxative, we performed PEG to deflate the gastrointestinal tract. An abdominal x-ray taken after the PEG placement showed the elimination of the gas and a remarkable improvement in the gastric dilatation, and the abdominal symptoms soon disappeared. These cases highlight the clinical importance and usefulness of PEG for gastric decompression in patients with aerophagia associated with repeated intestinal obstruction.

Open Gastrostomy by Mini-Laparotomy: Our Method

“…If a patient experiences abdominal distension due to compression, gastrostomy may be recommended for decompression. This is because swallowing excessive amounts of air can lead to ileus, which can cause intestinal dilation and ultimately require surgical intervention [ 5 ].…”

Percutaneous Endoscopic Gastrostomy with Jejunal Extension for an Encapsulating Peritoneal Sclerosis Refractory to Surgical Enterolysis

“…When the risk of stomach content aspiration is high, PEG-J, in which a tube is extended into the jejunum through the PEG tube, is applicable. Percutaneous endoscopic gastrostomy and PEG-J have also been used for bowel decompression in malignant and nonmalignant obstructions (7,8). In this case, although EPS was refractory to surgical treatment, the bowel obstruction symptoms were reduced by the sustained drainage of digestive juices through PEG-J, along with frequent supplementation of body fluid with saline during HHD.…”

Esophagogastric separation and abdominal esophagostomy via jejunal interposition: a new operation for extreme forms of pathologic aerophagia

“…In mentally retarded patients, emergency operations are sometime required because of abdominal distention owing to intraluminal air or volvulus of the intestine [4][5][6][7].…”