Gastric perforation after gastropexy with T-fasteners: a case report

Introduction Gastrostomy insertion is a common pediatric procedure, performed in multiple different ways, with an overall high complication rate, but few major complications. Life-threatening complications following elective gastrostomy insertion using gastropexy T-fasteners can occur. Case Presentation A 22-month-old male patient with a background of Pierre Robin sequence, tracheostomy for obstructed airway, Diamond-Blackfan anaemia, and nasogastric tube feed dependence, underwent a routine elective laparoscopic gastrostomy insertion using four gastropexy T-fasteners. He was discharged home on post-operative day 3, with normal observations tolerating full feeds. On day 5 he became unwell with features of abdominal sepsis, requiring emergency laparotomy which revealed peritonitis due to 3 T-fasteners cutting through the stomach wall causing 3 perforations. He underwent washout, repair of the perforations and revision of the gastrostomy. He required ventilatory and inotropic support on the paediatric intensive care unit for 2 weeks after surgery. After recovery from severe sepsis, he developed a gastrocutaneous fistula that was treated with gastric decompression, total parenteral nutrition, fluid and electrolyte management of fistula losses, and wound management. Balloon gastrostomy tubes were placed through the fistula on different occasions, under fluoroscopy and endoscopic guidance, in an attempt to control the effluent, that did not help. Gradually the fistula closed, allowing gastrojejunal feeding, and after 6 months button gastrostomy feeds. Conclusion Gastric perforation should be ruled out in patients who underwent a gastrostomy with T-fasteners and develop peritoneal signs in the postoperative period.