White Peritoneum

Misadventure of the Gastrostomy Tube (GT) has been described in the literature resulting in complications [1]. Here we present a case of dislodged GT diagnosed by contrast administration. The infant underwent GT placement for nutritional support. On the third post-operative day, she was started on Pedialyte solution five ml every three hours. Soon after the second feed, the infant was reported by the nurse to be agitated despite adequate sedation and pain management. Abdominal examination at that time showed slight distension. An urgent abdominal x-ray was obtained that showed tiny amount of free intraperitoneal air between the liver and the lateral abdominal wall and free air under the diaphragm figure A. The infant was immediately made nil per mouth and intravenous antibiotics were started. A contrast study was performed via GT that showed ‘white peritoneum’ figure B. All the contrast administered was noted to be intraperitoneal surrounding the bowel and liver and within the pericolic gutters. Infant was taken to the OR and GT was replaced. Infant tolerated the procedure well and remained stable post-operatively