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The subdiaphragmatic angle of the gastric tube in neonates: a potential predictor for perforations?

Background Traumatic subdiaphramatic perforation of esophagus or stomach in neonates represents a rare clinical complication following the insertion of a gastric tube and is associated with high morbidity and mortality. The aim of the present study was to evaluate whether the angle of the gastric tu...

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Main Authors: Diez, Sonja (Author) , Bartos, Hilda-Brigitta (Author) , Siemes, Anna (Author) , Gerleve, Hubert (Author) , Schock, Alexandra (Author) , Besendörfer, Manuel (Author) , Mahnken, Andreas H. (Author) , Weiß, Christel (Author) , Felderhoff-Müser, Ursula (Author) , Müller, Hannah (Author)
Format: Article (Journal)
Language:English
Published: 14 December 2023
In: Klinische Pädiatrie
Year: 2025, Volume: 237, Issue: 5, Pages: 259-265
ISSN:1439-3824
DOI:10.1055/a-2187-5404
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1055/a-2187-5404
Verlag, lizenzpflichtig, Volltext: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2187-5404#info
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Author Notes:Authors: Sonja Diez, Hilda Bartos, Anna Siemes, Hubert Gerleve, Alexandra Schock, Manuel Besendörfer, Andreas H. Mahnken, Christel Weiß, Ursula Felderhoff-Müser, Hanna Mueller
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Summary:Background Traumatic subdiaphramatic perforation of esophagus or stomach in neonates represents a rare clinical complication following the insertion of a gastric tube and is associated with high morbidity and mortality. The aim of the present study was to evaluate whether the angle of the gastric tube depicted on a plain radiograph may serve as a diagnostic tool to predict subdiaphragmatic traumatic (or iatrogenic) perforation.Patients and methods Thoraco-abdominal radiographs of 128 preterm and term neonates without perforation and 15 neonates with perforation of the esophagogastric junction or the stomach were retrospectively analysed.Results The angle of the gastric tube increases with postnatal age (p=0.0380). In the control group, the angle of the gastric tube varied between 13 degrees and 48 degrees (median: 31 degrees), whereas the values ranged from -31 degrees to 42 degrees (median: 11 degrees) in neonates with subdiaphragmatic perforation. Perforation should thus be suspected in cases with an angle of<20 degrees (sensitivity: 93.3%; specificity: 91.4%). Moreover, an unusual localization of the tip beyond the gastric bubble is highly indicative of perforation.Conclusions In daily clinical practice, an angle of<20(degrees) should be followed by thorough physical examination, abdominal ultrasound and if applicable contrast medium examinations to exclude perforation.
Item Description:Gesehen am 22.04.2024
Physical Description:Online Resource
ISSN:1439-3824
DOI:10.1055/a-2187-5404

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