Point-of-Care Ultrasound for Early Detection of Pneumoperitoneum Following Percutaneous Gastrostomy and the Use of the Shifting Phenomenon.

Pneumoperitoneum, the presence of free air in the abdominal cavity, is a known complication of percutaneous gastrostomy tube placement. While often benign and self-limiting, persistent or symptomatic pneumoperitoneum may indicate underlying gastrostomy dysfunction or gastrointestinal perforation, requiring prompt recognition and intervention. We report the case of a 19-year-old patient admitted to the Intensive Care Unit after a high-impact trauma, who developed abdominal pain and distension following percutaneous gastrostomy placement. Bedside ultrasound revealed the presence of reverberation artifacts consistent with free intraperitoneal air, with dynamic changes observed upon probe pressure, suggesting a shifting phenomenon. Computed tomography (CT) confirmed extensive pneumoperitoneum, and surgical exploration identified gastrostomy tube leakage, necessitating repositioning. The patient had an uneventful postoperative course. This case highlights the role of point-of-care ultrasound as a valuable bedside tool for the early detection of pneumoperitoneum, particularly in critically ill patients. While CT remains the gold standard, ultrasound provides a rapid, non-invasive, and radiation-free alternative for initial assessment, facilitating timely diagnosis and management.