Pediatric emergency medicine trisk 4677 4677

FIGURE 135.11 The button: Replacement gastrostomy device Leaking Leaking can occur directly from the lumen of the tube or from the peristomal area Leaking from the stoma often indicates that the stoma has widened and now exceeds the size of the tube Determining whether the leaking substance is formula, pus, or gastric fluid is important in the management If purulent drainage is coming from the stoma, the physician needs to look further for signs of stomal cellulitis or peristomal abscess (see the next section) If formula is leaking from the lumen of the tube, the physician must assess the tube position and check the balloon In the case of a leaking button, problems with valve patency could occur If fluid is leaking from the stoma, the stoma may have become larger than the tube One approach to this problem is removing the tube for a short period, thus allowing constriction of the stoma The stoma may also have become disrupted and therefore requires surgical evaluation Reflux Gastroesophageal reflux may be a complication of G-tube placement An increase in prior reflux disease can occur when a Nissen fundoplication is not performed simultaneously The patient may present with an increase in episodes of vomiting and symptoms of esophageal irritation after G-tube placement Patients in this category may benefit from continuous enteral feedings If continuous feedings are not effective in reducing symptomatic reflux, fundoplication may be indicated Gastric Ulceration Gastric irritation leading to ulceration may occur as a complication of gastrostomy in several scenarios If the tip of the G-tube is too long, it may abrade the opposite surface of the stomach mucosa, resulting in bleeding or traumatic ulceration Similarly, the balloon may accidentally become overinflated and cause friction, especially when the stomach is empty Balloon