Massive Septic Shock and Complex Survivorship in a Medically Complex Pediatric Patient Following Gastrostomy Tube Malposition With Operative Findings of Feed Within the Retrorectus Space.

Gastrostomy tube (G-tube) replacement is often routine; however, in children with complex medical needs, misplacement can rapidly lead to life-threatening complications. We describe the case of a 16-year-old male patient with neuronal ceroid lipofuscinosis who developed fulminant septic shock after accidental G-tube dislodgement and malposition. At an outside hospital, reinsertion attempts required tract dilation; bloody aspirate and inconclusive radiographs were overlooked, and feeds were resumed at home. After 48 hours, the patient presented to a community hospital in profound shock (blood pressure 40/20 mmHg, lactate 7.8 mmol/L, procalcitonin >50 ng/mL) with extensive abdominal wall emphysema and feed extravasation into the scrotum. Despite maximal fluid resuscitation, he required norepinephrine, epinephrine, vasopressin, broad-spectrum antibiotics, intubation, and central line placement. Pediatric surgery at a tertiary center advised immediate source control prior to transfer; local surgeons performed emergent laparotomy, washout, and vacuum-assisted closure. Cultures grew