b. Presentation may be subtle: recognition requires a

high index of suspicion.

c. Symptoms range from early feeding intolerance to

worsening abdominal pain/peritonitis and signs of

systemic infection.

d. Common early complications

(1) Wound infection, dehiscence

(2) Prolonged ileus, gastric atony leading to feeding

intolerance

(3) Gastric separation from anterior abdominal wall

(4) Intraperitoneal spillage/gastric leak leading to

peritonitis

(5) Early tube dislodgement

(6) Early tube occlusion

(7) Gastric outlet obstruction

3. Remote (late) complications

a. Common remote complications

(1) Dislodgement

(a) Inadvertent removal

(b) Internal or external gastrostomy migration

(20)

(2) Catheter deterioration

(a) Tube erosion/fracture

(b) Balloon rupture

Chapter 41 ■ Gastrostomy 291

(3) Tube occlusion

(4) Granulation tissue formation

(5) Persistent leak

(a) Wound breakdown

 i. Granulation tissue and skin irritation

 ii. Infection

iii. Enlargement of tract leading to loose

gastrostomy with leakage

iv. Skin ulceration

(b) Electrolyte imbalance

(c) Malnutrition

(6) New-onset or worsening GERD (21).

(7) Persistent gastrocutaneous fistula (post removal)

(8) Prolapse of gastric mucosa

(a) Bleeding

(b) Excessive leakage.

(9) Gastric torsion around catheter

b. Prevention

(1) Requires meticulous hygiene and appropriate

perpendicular positioning to avoid trauma to the

skin and subcutaneous tissues

(2) Parental education is essential to long-term care

and prevention of complications.

4. Treatment of Common Complications

a. Gastrostomy leak—treat early

(1) Remove tube for up to 24 hours to allow partial

tract closure.

(2) Replace mushroom catheter with a balloon-type

catheter.

Secure tube by pulling the balloon (inflated

with 2 to 5 mL of water) against the abdominal

wall.

(3) Apply Stomahesive around catheter.

(a) Decrease excoriation.

(b) Encourage epithelialization.

(c) Change Stomahesive every 3 to 4 days to

maintain seal.

(4) Maintain perpendicular positioning of gastrostomy tube.

(5) Do not clamp the gastrostomy tube.

(6) Maintain skin and stoma hygiene

5. Cleanse daily with soap and water.

Consider half-strength hydrogen peroxide for areas

of fibrinous exudate.

6. Frequent dressing changes to maintain a dry site.

a. Granulation tissue at gastrostomy site

(1) Silver nitrate

(a) Apply daily for up to 3 to 5 days.

(b) Avoid spilling the liquefied silver nitrate

onto normal adjacent skin since this will

cause a chemical burn.

(2) 0.5% Triamcinolone ointment

Apply three times a day for 5 to 7 days.

(3) Cautery

May require local or general anesthesia.

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