Laparoendoscopic evaluation and treatment of massive pneumoperitoneum occurring 1 year after gastrostomy tube removal.

A 48-year-old man presented with massive pneumoperitoneum approximately 1 year after removal of a gastrostomy tube. A combined laparoscopic and endoscopic evaluation was used to identify and resect the gastric perforation at the previous gastrostomy site. To our knowledge, this is the longest interval reported in the literature for development of pneumoperitoneum after percutaneous endoscopic gastrostomy. A laparoendoscopic approach to evaluation and treatment of pneumoperitoneum in this setting is described.