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

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.

Two Cases of Gastrocolocutaneous Fistula with a Long Asymptomatic Period after Percutaneous Endoscopic Gastrostomy

“…Recently, endoscopic treatment of fistulas has been attempted, although surgery is often required. 16 , 17 , 18 In our first case, the gastrocolic fistula was successfully sealed using metal clips during colonoscopy, and the colocutaneous fistula spontaneously closed.…”

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

“…There have been attempts at endoscopic treatment of fistulae after removal of PEG tube ( Table 2 ) [ 4 , 7 , 9 , 15 - 20 ]. Hwang et al suggested that endoscopic treatments would be helpful in cases where the fistula does not spontaneously close within several days [ 17 ]. Kim et al suggested that endoscopic closure would accelerate the blockage of the fistula in patients with a risk of delayed wound healing and infection (e.g., diabetes mellitus) [ 18 ].…”

“…The method of endoscopic treatment is likely determined according to the size of the fistula opening. Small fistula tracts were treated only with hemoclips, but detachable snare with clips, over-the-scope clip, and cardiac septal defect closure device have been used for relatively large fistula openings [ 4 , 9 , 17 - 20 ]. In our case, we used hemoclips to close the fistula, and argon plasma coagulation was performed before clipping to help mucosal adhesion.…”

Gastrocolic fistula as a complication of percutaneous endoscopic gastrostomy (PEG): a case report and review of literature

“…• When fistula does not close spontaneously even after conservative treatment. 15 • Patients where delayed wound healing and infection is expected. 4 • Large fistulous opening which definitely needs surgical intervention.…”