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CC-011 Case report: colocutaneous fistula – a rare complication of PEG tube insertion
  1. A M Verma,
  2. J A D Stewart
  1. Department of Gastroenterology, Leicester Royal Infirmary, Leicester, UK

Abstract

Introduction A 69-year-old man with myotonia and history of partial gastrectomy for ulcer presented in Apr 09 with 2-wk history of diarrhoea and PEG site infection, it was noted that the discharge from the PEG tube and site was offensive. The PEG tube had been placed in 05 for swallowing difficulties with no apparent complications.

Methods OGD revealed a small “hole” visible in the anterior gastric wall, surrounded by inflamed tissue. A abdominal CT showed the internal bumper and tube sited within the transverse colon.

When the PEG was sited, it was placed through the transverse colon into the stomach, forming a tract. The internal bumper had eventually eroded through the stomach in 09, passing through the tract and finished in the transverse colon. This caused a faecalent discharge from the PEG. The remnant gastrocolic fistula caused the diarrhoea.

Results The PEG tube was cut externally and allowed to pass through defecation. Patient was fed with a NG tube. Colocutaneous fistula remained patent. Diarrhoea had stopped, indicating closure of gastrocolic fistula.

Radiological feeding tube insertion was attempted and abandoned as the transverse colon was adherent to the stomach. A PEG insertion was abandoned as trans-illumination was unsuccessful. The patient was not suitable for a surgical feeding tube insertion and he was discharged with long-term NG tube feeding.

Conclusion PEG tube placement was first described in 1980.1 It is a safe technique to allow long-term feeding in patients with swallowing difficulties of various aetiologies. However, placement of PEG tubes are not without risk. Approximately 4% of patients experience major complications, such as gastric perforation, gastric bleeding, haematoma, aspiration and death. Another 13% may experience relatively minor complications, such as wound infection, tube dislodgment, aspiration, stomal leak, fever, or ileus.2

Colocutaneous fistulas are a rare complication of PEG tube insertion with only a small number of case reports cited in a Medline literature search.3 ,4 This appears to be a higher risk in patients who have undergone a partial gastrectomy, possibly due to the colon migrating into the space around the remnant stomach and/or adhesions.5

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