Case: A 4 yo developed abdominal distention and crepitus after gastrostomy tube (GT) placement. An AXR (see below) showed subcutaneous emphysema (especially in left abdomen). There was no pneumoperitoneum or extravasation of contrast with fluoroscopy. Due to persistent distention, a CT scan was obtained three days after tube placement. The CT scan confirmed appropriate intragastric location of GT and nonspecific dilatation of bowel loops without pneumoperitoneum; the dilated bowel was attributed to an ileus and improved over the next few days. Thanks to colleague for sharing information.

My take: Isolated subcutaneous emphysema is rarely identified after GT placement and requires careful evaluation to assure appropriate insertion site (1,2).

1. S Bernstein et al. AJR 2001;177:693–694 0361–803X/01/1773–693. Open Access: Subcutaneous Emphysema in a Pediatric Patient After Radiologic Placement of a Percutaneous Gastrostomy Tube
2. MM Wojtowycz, JA Arata . AJR 1988; 151:311–312. Subcutaneous emphysema after percutaneous gastrostomy.