ABSTRACT

The use of non-invasive ventilation (NIV) has become increasingly popular in the treatment of children with acute or chronic respiratory failure. Although NIV is well tolerated by most of the patients, various complications have been described. Herein, we describe a patient who developed early gastrostomy dislodgement related with NIV.

A seven-year-old male patient with cerebral palsy and epilepsy was admitted to our pediatric intensive care unit after laparoscopic Nissen fundoplication and gastrostomy. On postoperative day 2, he had self-extubated and NIV was performed for respiratory distress. The feeding was started on postoperative day 3 and gastric decompression was stopped. There were diffuse erythema and significant tenderness around the gastrostomy site and subcutaneous crepitations on the abdominal wall two days after the feeding was started. Laparatomy was performed, dislodgement of gastrostomy was observed, and a leakage was found between the stomach and the abdominal wall. Gastrostomy revision was done.

Although early postoperative course of laparoscopic gastrostomy and Nissen fundoplication is not a contraindication for NIV, unexpected complications can be seen. Feeding from gastrostomy tube should be delayed and gastric decompression should be provided during early postoperative course in case of NIV requirement.

Keywords: non-invasive ventilation, laparoscopic gastrostomy, Nissen fundoplication, gastrostomy dislodgement