Ann Rehabil Med.  2015 Feb;39(1):133-137. 10.5535/arm.2015.39.1.133.

Conversion of Percutaneous Endoscopic Gastrostomy to Gastrojejunostomy Under Fluoroscopic Guidance for Treatment of Gastrocutaneous Fistula

• Kim JS
• Baik JH
• Lim SH
• Hong BY
• Jo L

• KMID: 2273030
• DOI: http://doi.org/10.5535/arm.2015.39.1.133

Abstract

Persistent enterocutaneous fistula after the removal of a gastrostomy tube is an unusual complication of percutaneous endoscopic gastrostomy (PEG). The following case report describes an 81-year-old man diagnosed with stroke and dysphagia in May 2008. The patient had been using a PEG since 2008, and PEG site infection occurred in June 2013. The PEG tube was removed and a new PEG tube was inserted. Thereafter, formation of gastrocutaneous fistula around the previous infected PEG site was observed. The fistula was refractory to medical management, accompanied by long duration of fasting and peripheral alimentation. Therefore, gastrojejunostomy tube insertion via the previously inserted PEG tube was performed, under fluoroscopic guidance; this mode of management was successful. For patients who have a gastrocutaneous fistula, gastrojejunostomy tube insertion via the pre-existing PEG tube is a safe and effective alternative management for enteral feeding.

Keyword

Gastrostomy; Jejunostomy; Intestinal fistula

MeSH Terms

Aged, 80 and over
Deglutition Disorders
Enteral Nutrition
Fasting
Fistula*
Gastric Bypass*
Gastrostomy*
Humans
Intestinal Fistula
Jejunostomy
Stroke

Figure

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  Fig. 1 (A) A round swelling around the percutaneous endoscopic gastrostomy (PEG) and (B) enhancing soft tissue infiltration around the PEG site; subcutaneous layer (arrow) without peritonitis; abscess formation.

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  Fig. 2 One month after removal of the complicated percutaneous endoscopic gastrostomy, the skin appears to have healed.

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  Fig. 3 A new percutaneous endoscopic gastrostomy (PEG) is inserted 2 cm above the site of the previous PEG insertion.

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  Fig. 4 (A) A newly inserted PEG (arrow) and (B) fistula along the previous PEG site (arrow). PEG, percutaneous endoscopic gastrostomy.

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  Fig. 5 (A) Gastrojejunostomy tube insertion under fluoroscopy guidance via the previous percutaneous endoscopic gastrostomy (PEG) site (arrow); the tip of the catheter is placed in the jejunum (arrow head). (B) Insertion of the gastrojejunostomy tube into the PEG.

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