Peritonitis is a rare but serious complication related to G or GJ tube insertion. Find out what causes peritonitis related to G and GJ tubes, the signs and symptoms, and how it’s treated.
Key points
Peritonitis is a rare complication of G or GJ tube insertion.
Peritonitis is the inflammation of the inner lining of the abdominal wall, which covers all the organs within the abdomen.
Risk for developing peritonitis is highest in the first few days after tube insertion. It can also happen after a tube exchange if the newly exchanged tube is misplaced and feeds are given outside the stomach.
If you have any concerns that your child may have peritonitis, do not use your child’s tube for feeds, fluids or medications. Do not feed your child by mouth. Visit the nearest emergency department immediately.
Introduction
Gastrostomy tubes (G tubes) and gastrojejunostomy tubes (GJ tubes) are feeding devices that support children who are unable to safely or adequately eat or drink by mouth. A G tube provides liquid nutrition, medication and other fluids directly into the stomach. A GJ tube gives liquid nutrition, medication and other fluids past the stomach directly into the second part of the small bowel, called the jejunum. Both G tubes and GJ tubes are placed through a small, surgical opening in your child’s tummy (abdomen) called a stoma. The tunnel from the outside of the body into the stomach is called the tract.
A G or GJ tube is easily managed by families and caregivers. However, there can be complications related to G or GJ tube insertion or exchanges.
Peritonitis is one of the possible complications related to G or GJ tube insertion or exchange. Peritonitis is a very uncommon but serious condition that requires immediate medical attention.
More information
What is peritonitis?
Peritonitis is the inflammation of the inner lining of the abdominal wall (parietal peritoneum) and tissues covering your organs (visceral peritoneum).
When peritonitis is related to a G or GJ tube, it is often caused by stomach contents leaking into the space that surrounds the stomach and bowel (peritoneal cavity). Your child’s medical team will watch very closely for signs of peritonitis during their hospital stay after tube insertion.
Normal G tube placement vs peritonitisPeritonitis may occur if the G tube is misplaced into the peritoneal cavity, instead of directly into the stomach. Stomach contents may leak into the space that surrounds the stomach and bowels, causing inflammation of the peritoneum.
Peritonitis may also occur when a tube is misplaced into the peritoneal cavity, rather than directly into the stomach. This may happen if you exchange the tube at home or it is exchanged at the hospital. Always monitor your child for signs and symptoms of peritonitis after a tube change, whether they are at home or at the hospital. A child is at higher risk for peritonitis after a tube exchange. Tube exchanges usually happen as an outpatient, so it is important that you watch for signs of peritonitis for the first several days at home.
Signs and symptoms
What are the signs and symptoms of peritonitis?
A child with peritonitis may show one or more of the following.
If you suspect that your child may have peritonitis,
do not use your child's tube for feeds, fluids or medications. Do not feed your child by mouth. Visit the nearest emergency department immediately and let them know that your child has recently had a tube insertion or exchange.
Peritonitis is a serious condition that can lead to significant problems and, in severe, untreated cases, death.
Causes, risk factors and prevalence
Risk factors for peritonitis
The risk of peritonitis is highest at these times:
Within the first few days after the primary insertion of a G or GJ tube. The risk of peritonitis after the primary insertion is 1-3%.
After using a temporary tube, such as a Foley catheter, for feeds, medication or fluids without first confirming the tube is properly placed in the stomach.
Diagnosis
Diagnosis of peritonitis
When your child arrives at the hospital, they will need to be assessed to determine if they have peritonitis.
The assessment may include the following.
A physical examination of your child’s abdomen to determine if their abdomen is distended, tender or has absent bowel sounds assessed using a stethoscope to the abdomen
Blood tests
X-rays
Ultrasounds
A check of the G or GJ tube placement
Treatment
Treatment of peritonitis
Multiple antibiotics are usually given to treat peritonitis. The type of antibiotics will depend on the severity of the peritonitis.
Your child’s feeds may need to be stopped for a few days while they get better. Your child will need to be admitted for the treatment of peritonitis.
On rare occasions, a surgery may be needed to clean out the infection in the abdomen.
At SickKids
Contact your G tube specialist if you have any questions or concerns about your child’s feeding tube or about peritonitis. If you suspect your child has peritonitis, take your child to the Emergency Department right away.
