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Percutaneous endoscopic gastrostomy (PEG) is a safe and widely used technique to establish an enteral feeding route. It has eliminated much of the operative morbidity associated with gastrostomy placed by laparotomy. The authors recently observed a patient who developed a benign pneumoperitoneum following PEG. Twenty-four patients were then prospectively studied after PEG to determine the incidence and significance of this finding. Nine patients (38%) developed radiologic pneumoperitoneum. Five patients (21%) had gross evidence of pneumoperitoneum, three patients had more subtle findings of small amounts of free air, and one patient had free air found by CT scan. No patient developed signs or symptoms of peritoneal inflammation. The authors conclude that pneumoperitoneum following PEG occurs frequently and that, in the absence of signs or symptoms of peritoneal inflammation, it is a benign finding which requires no further diagnostic or therapeutic intervention.

A prospective study of 25 consecutive premature infants under 1,500 g was undertaken to evaluate the frequency and sonographic appearance of subependymal germinal matrix hemorrhage. In all 12 sonographically positive cases, the hemorrhage was initially imaged in the area immediately anterior to the caudothalamic groove. Special attention to this area permits early detection of germinal matrix hemorrhage, and neurosonography of neonates should be considered incomplete unless this area has been thoroughly imaged.

Serial neurosonography was performed in 210 high-risk, preterm neonates. Eleven (5.8%) demonstrated small cystic formations in the subependymal lining of the lateral ventricles. These subependymal cysts were unilateral and were detected at the exact site of a previous subependymal hemorrhage in two cases. These 11 infants were not significantly different in maturity, size, or clinical parameters from our main high-risk newborn population. Ten survivors had marked motor retardation at follow-up ages of 9-13 months, and one died from neonatal sepsis.

The technique, results, and complications of 109 consecutive sonographically guided therapeutic paracenteses performed on 43 patients with malignant ascites are summarized. A 5.5-French Sacks One-Step Catheter was used in all cases but five in which tissue resistance prohibited passage of the catheter through the abdominal wall. The procedure was performed on an inpatient basis 70 times and in an outpatient setting 39 times. Colonic, ovarian, and breast carcinomas accounted for over 50% of the tumors resulting in malignant fluid collections. Three complications (hypotension, 2.6%) were directly related to the procedure; two of them were fatal (1.6%). The amount of ascitic fluid drained within the first 24 hr averaged 3.5 l at rates of 100-150 ml/sec. Ninety-five procedures (87%, in 39 patients) resulted in improvement of symptoms after drainage as manifested by decreased pain from abdominal distention, alleviation of nausea, improved appetite, or decreased dyspnea. The duration of symptomatic relief ranged from 4 days to 45 days (mean, 10.4 days). Sonographically guided paracentesis is an effective procedure that can be performed for short-term relief of symptoms caused by malignant ascites.

Pelvic recurrence is a common cause of symptoms and mortality in patients who have undergone surgical resection of rectal carcinoma. Diagnosis by physical examination and standard radiologic techniques is usually only possible when the recurrence becomes symptomatic because of its advanced state. Previous reports have documented the ability of computed tomography (CT) to depict accurately pelvic recurrence of rectal carcinoma in the symptomatic patient. Surgical resection of recurrence is usually noncurative but appears to result in a more prolonged survival if performed in the asymptomatic patient. We report a case of pelvic lymph node recurrence suggested by CT and confirmed by CT guided needle biopsy in an asymptomatic patient. Diagnosis of recurrence at this early stage by CT, supplemented with CT guided biopsy, may offer the patient an increased chance of survival following surgical resection.

Vermiform appendix is an unusual site of diverticulosis. We present 3 examples of this entity and briefly review its pathogenesis and clinical significance. As a general rule, appendiceal diverticula are multiple, acquired naturally, and rarely associated with complications.

Percutaneous endoscopic gastrostomy (PEG) is a safe and widely used technique to establish an enteral feeding route. It has eliminated much of the operative morbidity associated with gastrostomy placed by laparotomy. Although pneumoperitoneum can be seen after surgery and in association with certain endoscopic procedures, it has not been seen after percutaneous endoscopic gastrostomy. We describe a patient who developed a benign pneumoperitoneum after insertion of a percutaneous gastrostomy tube.