A Rare Complication of Percutaneous Endoscopic Gastrostomy: Necrotizing Fasciitis

Öz

Percutaneous endoscopic gastrostomy is a procedure where a feeding tube is passed percutaneously into the patient’s stomach under sedation. The procedure is carried out on patients whose gastrointestinal system is functional and, for various reasons, cannot be fed orally for a long time. Percutaneous endoscopic gastrostomy can cause minor and major complications. One of the rare but fatal major complications is necrotizing fasciitis. It is a soft tissue infection that involves the superficial fascia and subcutaneous tissue. Proper training of the patient/caregiver and continuity of care after discharge from the hospital are important for long-term use of the percutaneous endoscopic gastrostomy tube. Most complications can be effectively prevented if a high quality of care is present and appropriate measures are taken. In this article, a case of nectotizing fasciitis, a rare and mortal complication of percutaneous endoscopic gastroscopy, is presented. This case report aims to emphasize the major complications of percutaneous endoscopic gastrostomy that may progress mortally in the light of the literature that discusses how preventive measures carried out by critical-care nurses can be cost effective.

Anahtar Kelimeler

• Percutaneous endoscopic gastrostomy,necrotizing fasciitis,enteral nutrition,nurse care

Perkütan Endoskopik Gastrostomi Tüpünün Nadir Komplikasyonu: Nekrotizan Fasiit

Öz

Perkütan endoskopik gastrostomi çeşitli nedenlerden dolayı uzun süre ağızdan beslenemeyen hastalara, gastrointestinal sistem fonksiyonel ise sedasyon altında beslenme tüpünün perkütan olarak mideye yerleştirilmesi işlemidir. Perkütan endoskopik gastrostomi minör ve majör komplikasyonlara neden olabilir. Nekrotizan fasiit, yüzeyel fasia ve deri altı dokuyu tutan yumuşak doku enfeksiyonu olmakla birlikte, nadir görülen ancak ölümle sonuçlanabilen majör komplikasyonlardan biridir. Hasta/bakım vericinin uygun eğitimi ve hastaneden taburcu olduktan sonra bakımın sürekliliği perkütan endoskopik gastrostomi tüpünün uzun süreli kullanımı için önemlidir. Komplikasyonların çoğu, bakımın kalitesine bağlıdır ve uygun önlemler alınırsa etkili bir şekilde önlenebilir. Bu makalede perkütan endoskopik gastrostominin nadir ve mortal seyredebilen majör komplikasyonu olan nekrotizan fasiitli olgu sunulmuştur. Bu olgu sunumu vesilesi ile perkütan endoskopik gastrostominin mortal seyredebilen majör komplikasyonlarının hemşireler tarafından alınacak önleyici tedbirler ile maliyet etkin bir şekilde önlenebileceği literatür ışığında vurgulanması amaçlanmıştır.

Anahtar Kelimeler

• Perkütan endoskopik gastrostomi,nekrotizan fasiit,majör komplikasyon,enteral beslenme,hemşirelik bakımı

Kaynakça

1. 1. Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr 2020;39:5-22. 2. Anderloni A, Leoa MD, Barzaghi F, et al. Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: A multicenter prospective cohort study. Dig Liver Dis 2019;51:1380-7. 3. Gauderer M. Twenty years of percutaneous endoscopic gastrostomy: Origin and evolution of a concept and its expanded applications. Gastroint Endosc 1980;50:879-83. 4. Blumenstein I, Shastri YG, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol 2014;20:8505-24. 5. Özden D, Karagözoğlu Ş, Güler N, Bülbüloğlu S. Evde enteral tüple beslenen hastaların beslenmeye ilişkin yaşadığı sorunlar ve yakınlarının bakım yükü. DEUHFED 2016;9:134-41. 6. Özbaş N, Göçmen Baykara Z. The determination of the level of knowledge of nurses on enteral tube feeding. Journal of Human Sciences 2018;15:359-67. 7. Hemşirelik Yönetmeliği. (2010). 8 Mart Tarihli ve 27515 Sayılı Resmî Gazete. [e-mail]. Erişim tarihi: 15.01.2020. 8. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. (2019). 2018 Türkiye Nüfus ve Sağlık Araştırması, Temel Bulgular. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye. 9. Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 1997;103:18-24. 10. Das DK, Baker MG, Venugopal K. Increasing incidence of necrotizing fasciitis in New Zealand: A nationwide study over the period 1990 to 2006. J Infect 2011;63:429-33. 11. Psoinos CM, Flahive JM, Shaw JJ, et al. Contemporary trends in necrotizing soft-tissue infections in the United States. Surgery 2013;53:819-27. 12. Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med 2015;8:195-202. 13. Glass GE, Sheil F, Ruston JC, Butler PE. Necrotising soft tissue infection in a UK metropolitan 251 population. Ann R Coll Surg Engl 2015;97:46-51. 14. Chuang KL, Liang FW, Shieh SJ, Lu TH. The incidence of necrotizing fasciitis in Taiwan: A nationwide population-based study. Ann Plast Surg 2018;80(2S Suppl 1):S75-S78. 15. Goepfert AR, Guinn DA, Andrews WW, Hauth JC. Necrotizing fasciitis after cesarean delivery. Obstet Gynecol 1997;89:409-12. 16. Gallup DG, Freedman MA, Meguiar RV, Freedman SN, Nolan TE. Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency. Am J Obstet Gynecol 2002;187:305-10. 17. Lim YJ, Yong FC, Wong CH, Tan AB. Necrotising fasciitis and traditional medical therapy a dangerous liaison. Ann Acad Med Singapore 2006;35:270-3. 18. Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR. Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg 2007;119:1803-7. 19. Hefny AF, Eid HO, Al-Hussona M, Idris KM, Abu-Zidan FM. Necrotizing fasciitis: a challenging diagnosis. Eur J Emerg Med 2007;14:50-2. 20. Peer SM, Rodrigues G, Kumar S, Khan SA. A clinicopathological study of necrotizing fasciitis an institutional experience. J Coll Physicians Surg Pak 2007;17:257-60. 21. Grant DG, Bradley PT, Pothier DD, et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009;34:103-112. 22. MacLean AA, Miller G, Bamboat ZM, Hiotis K. Abdominal wall necrotising fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: A case series. Am Surg 2004;70:827-31. 23. Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol 2007;46:1036-41. 24. Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 2016;30:769-81. 25. Baloch UB, Noor H, Silverberg M. Abdomınal Wall Necrotızıng Fascittis: A rare complication of percutaneous gastrostomy. Chset Annuel Meeting. 2018;154(4):242. 26. Toussaint E, Gossum AV, Ballarin A, Arvanitakis M. Enteral access in adults. Clinical Nutrition 2015;34:350-8. 27. Lord LM. Enteral access devices: types, function, care, and challenges. Nutr Clin Pract 2018;33:16-38. 28. Roveron G, Antonini M, Barbierato M, et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients. J Wound Ostomy Continence Nurs 2018;45:326-34. 29. DeLegge MD. Enteral access and associated complications. Gastroenterol Clin N Am 2018;47:23-37. 30. Kahveci G, Dağcı S, Atalay R. A different perspective of hypergranulation tissue care in percutaneous endoscopic gastrostomy: A case report and review of the literature. Endoscopy Gastrointestinal 2019;27:65-7.