Clin Endosc.  2018 Mar;51(2):196-200. 10.5946/ce.2017.062.

Gastrocolocutaneous Fistula: An Unusual Case of Gastrostomy Tube Malfunction with Diarrhea

Affiliations
  • 1Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 2Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. hkna77@naver.com

Abstract

A gastrocolocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG). We report a case of a gastrocolocutaneous fistula presenting with intractable diarrhea and gastrostomy tube malfunction. A 62-year-old woman with a history of multiple system atrophy was referred to us because of PEG tube malfunction. Twenty days prior to presentation, the patient started developing sudden diarrhea within minutes after starting PEG feeding. Fluoroscopy revealed that the balloon of the PEG tube was located in the lumen of the transverse colon with the contrast material filling the colon. Subsequently, the PEG tube was removed and the opening of the gastric site was endoscopically closed using hemoclips. Clinicians should be aware of gastrocolocutaneous fistula as one of the complications of PEG insertion. Sudden onset of diarrhea, immediately after PEG feedings, might suggest this complication, which can be effectively treated with endoscopic closure.

Keyword

Gastrostomy; Complications; Fistula

MeSH Terms

Colon
Colon, Transverse
Diarrhea*
Female
Fistula*
Fluoroscopy
Gastrostomy*
Humans
Middle Aged
Multiple System Atrophy

Figure

  • Fig. 1. (A, B) Contrast radiography with gastrografin showing the balloon of the percutaneous endoscopic gastrostomy tube in the lumen of the transverse colon with contrast filling in the transverse colon.

  • Fig. 2. Endoscopic findings. (A) The gastric side of the fistula opening is shown at the anterior side of the body (B) Argon plasma coagulation was applied to the fistula opening. (C) Hemoclips were applied to close the fistula opening.

  • Fig. 3. Contrast-enhanced abdominal computed tomography revealing the gastrostomy tract in the left anterior abdominal wall anterior to the transverse colon.

  • Fig. 4. One week after removal of percutaneous endoscopic gastrostomy tube, contrast radiography showing no evidence of gastric leakage.


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