Clin Endosc.  2012 Mar;45(1):95-98. 10.5946/ce.2012.45.1.95.

A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

• Hwang JH
• Kim HW
• Kang DH
• Choi CW
• Park SB
• Park TI
• Jo WS
• Cha DH

• KMID: 2048839
• DOI: http://doi.org/10.5946/ce.2012.45.1.95

Abstract

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

Keyword

Percutaneous endoscopic gastrostomy; Gastrocolocutaneous fistula

MeSH Terms

Aged
Colon, Transverse
Colonoscopy
Enteral Nutrition
Female
Fistula
Gastroscopy
Gastrostomy
Humans
Infarction
SNARE Proteins
Stomach
SNARE Proteins

Figure

• 

  Fig. 1 Gastroscopic findings. (A) Percutaneous endoscopic gastroscopy (PEG) tube was inserted. (B) Six days after PEG, it was observed that the fecal materials were attached to gastric wall and that the end of PEG tube was partially buried.

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  Fig. 2 Contrast enhanced computed tomography scan findings, 1 day after percutaneous endoscopic gastroscopy tube removal. Red arrow indicates transverse colon located in anterosuperior site of stomach. A fistular tract between stomach, transverse colon and abdominal wall was also observed.

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  Fig. 3 Endoscopic findings. (A) A part of fistula was shown at colonoscopic finding. (B) During colonoscopy, primary closure was performed with hemo-clips. (C) Some of the end of hemo-clip located at the transverse colon was shown from gastric cavity side at gastroscopic finding. (D) During gastroscopy, the fistula at gastric side was also sutured with hemo-clips and then detachable snare was applied for concrete suture.

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  Fig. 4 Gastroscopic findings, 6 days after the endoscopic treatment. The closure of fistula was confirmed.

Reference

1. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987; 93:48–52. PMID: 3108063.

2. Mamel JJ. Percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1989; 84:703–710. PMID: 2500845.

3. Wicks C, Gimson A, Vlavianos P, et al. Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding. Gut. 1992; 33:613–616. PMID: 1612476.

4. Hull MA, Rawlings J, Murray FE, et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet. 1993; 341:869–872. PMID: 8096573.

5. Onishi J, Kuzuya M, Sakaguchi H. Survival rate after percutaneous endoscopic gastrostomy in a long-term care hospital. Clin Nutr. 2004; 23:1248–1249. PMID: 15380920.

6. Schrag SP, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007; 16:407–418. PMID: 18193123.

7. Kierstead BS, Khan A, Ruppert E, Bobo R. Colocutaneous gastric fistula: a complication of percutaneous endoscopic gastrostomy. Pediatr Surg Int. 1991; 6:134–135.

8. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980; 15:872–875. PMID: 6780678.

9. Huang SY, Levine MS, Raper SE. Gastrocolic fistula with migration of feeding tube into transverse colon as a complication of percutaneous endoscopic gastrostomy. AJR Am J Roentgenol. 2005; 184(3 Suppl):S65–S66. PMID: 15728025.

10. Smyth GP, McGreal GT, McDermott EW. Delayed presentation of a gastric colocutaneous fistula after percutaneous endoscopic gastrostomy. Nutrition. 2003; 19:905–906. PMID: 14559330.

11. Khattak IU, Kimber C, Kiely EM, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg. 1998; 33:67–72. PMID: 9473103.

12. Croaker GD, Najmaldin AS. Laparoscopically assisted percutaneous endoscopic gastrostomy. Pediatr Surg Int. 1997; 12:130–131.

13. Patwardhan N, McHugh K, Drake D, Spitz L. Gastroenteric fistula complicating percutaneous endoscopic gastrostomy. J Pediatr Surg. 2004; 39:561–564. PMID: 15065028.

14. Shellito PC, Malt RA. Tube gastrostomy. Techniques and complications. Ann Surg. 1985; 201:180–185. PMID: 3918515.