Background Percutaneous endoscopic gastrostomy is a commonly used endoscopic technique where a tube is placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition. Several placement techniques are described in the literature with the ‘pull’ technique (Ponsky-Gardener) as the most popular one. Independent of the method used, placement includes a ‘blind’ perforation of the stomach through a small acute surgical abdominal wound. It is a generally safe technique with only few major complications. Nevertheless these complications can be sometimes life-threatening or generate serious morbidity. Method A narrative review of the literature of major complications in percutaneous endoscopic gastrostomy. Results This review was written from a clinical viewpoint focusing on prevention and management of major complications and documented scientific evidence with real cases from more than 20 years of clinical practice. Conclusions Major complications are rare but prevention, early recognition and popper management are important.

https://bmjopengastro.bmj.com/content/bmjgast/8/1/e000628.full.pdf

Prevention and management of major complications in percutaneous endoscopic gastrostomy.

http://manuscript.elsevier.com/S0960896621006726/pdf/S0960896621006726.pdf

Idiopathic eosinophilic myositis: a systematic literature review

Rhabdomyolysis-induced acute kidney injury in a patient with undifferentiated connective tissue disease: A case report and literature review rhabdomyolysis-induced AKI in a patient with UCTD.

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

/pdf/obshchie-printsipy-profilaktiki-i-lecheniia-oslozhnenii-4zu6qg5t7x.pdf

Общие принципы профилактики и лечения осложнений чрескожной эндоскопической гастростомы (обзор литературы)

Introduction Intramural hematomas of the gastrointestinal tract are uncommom, usually located in the esophagus or duodenum, with idiophatic or secondary causes. We present a very rare case of gastric intramural hematoma caused by an unpublished etiology, with literature review. Case presentation An elderly woman suffered acute thoracic aorta dissection followed by gastric intramural hematoma, diagnosed through endoscopy and computed tomography angiography. The treatment included endovascular aortic repair and conservative management. Discussion The postulated mechanism for the bleeding in gastric intramural hematoma is shredding of terminal arteries at the point of penetration into the muscular layer with subsequent dissection of the muscularis propria from the submucosa. The most frequently cited risk factor is hemorrhagic diathesis/anticoagulant use and the main etiologies are trauma and post-interventional endoscopy. In the diagnosis work-up, computed tomography is the method of choice, usually associated with endoscopy. There is no standard of care for such rare condition. Thus, treatment may be cause-dependent, ranging from conservative to minimally invasive and/or surgery. Conclusions Gastric intramural hematoma is a rare disorder with many causes and we described a new etiology for it. The computed tomography is the diagnostic modality of choice, with the aid of other examinations. The treatment comprises conservative measures, minimally invasive approach or most commonly surgery.

Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review.

BACKGROUND Intramural hematomas primarily present in the esophagus or duodenum. We report a case of intramural hematoma in the gastric wall (GIH) secondary to percutaneous endoscopic gastrostomy (PEG) tube placement in a setting of platelet dysfunction. CASE REPORT This case study reviews the hospitalization of a 73-year-old male with a history of chronic kidney disease who was admitted for coronary artery bypass graft surgery and mitral valve repair. During his complicated hospital course, he inadvertently required the placement of a PEG tube. His coagulation profile prior to this procedure was within normal limits. The patient had no history of coagulopathy and was taking aspirin 81 mg per day. PEG tube placement was withheld due to an expanding hematoma that was noted at the site of needle insertion in the gastric wall. A single dose of intravenous desmopressin (0.3 microgram/kilogram) was administered under the suspicion of uremic bleeding. No further gastrointestinal bleeding events were observed. A platelet function assay (PFA) and collagen/epinephrine closure time indicated platelet dysfunction. Three days later, we again attempted a PEG tube placement. His PFA prior to this procedure had normalized due to aspirin discontinuation and improvement of renal function. Esophagogastroduodenoscopy (EGD) showed an area of flat bluish gastric submucosal bruising at the site of the previous hematoma. The PEG tube was placed successfully at an adjacent site. Over the course of the following month, the patient underwent uneventful feeding through the PEG tube. CONCLUSIONS To our knowledge, cases of GIH are rarely documented in literature. Multidisciplinary vigilance is required to maintain a high index of suspicion for this complication in patients with uremia or other coagulopathies to aid in prompt diagnosis.

Intraoperative Gastric Intramural Hematoma: A Rare Complication of Percutaneous Endoscopic Gastrostomy

Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

/pdf/severe-rhabdomyolysis-without-systemic-involvement-a-rare-4dqal3evgx.pdf

Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess.

/pdf/paraspinal-and-extensive-epidural-abscess-the-great-45xnbsve8k.pdf

Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain.

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Intraoperative Gastric Intramural Hematoma: A Rare Complication of Percutaneous Endoscopic Gastrostomy

Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain.