Gastrocolocutaneous fistula: An undetected complication of colon transfixation during percutaneous endoscopic gastrostomy

Nunes, Gonçalo; Oliveira, Gabriel; Cortez-Pinto, João; Cruz, João; Fonseca, Jorge

doi:10.5152/tjg.2018.18552

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…This is due to their infrequency, often requiring a decade's worth of patients in order to study a cohort with a specific complication, such as buried bumper syndrome. [5][6][7] Very little is documented in the literature about the nonendoscopic-related, and potentially less serious, complications that occur, particularly beyond the 30-day postinsertion period. Equally, there is little evidence on the impact of these late and less serious complications on the patient and healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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The Hidden Burden of Community Enteral Feeding on the Emergency Department

Barrett

Merrick

et al. 2020

J Parenter Enteral Nutr

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Background: Enteral feeding tubes are associated with their most serious complications in the days and weeks after insertion, but there are limited published data in the literature on late complications and the implications for the healthcare service. Methods: This is a retrospective observational study of attendances to a UK hospital emergency department (ED), with enteral tube complications as the primary reason for attendance. Results: Over 24 months, 139 attendances were recorded. Dislodged tubes and blocked tubes accounted for the majority of complications and subsequent admissions, with a mixture of enteral tube types being associated with both. Thirty-five percent of patients were admitted, and the average healthcare cost per attendance was $1071. Conclusion: Enteral tube complications can place a hidden burden on the patient, the ED, and healthcare costs. More work on education and supporting caregivers to resolve problems themselves could reduce the burden on busy EDs.

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Section: Introductionmentioning

confidence: 99%

“…Serious complications that occur late, or are identified late, are represented in the literature in the form of case reports. This is due to their infrequency, often requiring a decade's worth of patients in order to study a cohort with a specific complication, such as buried bumper syndrome 5–7 …”

Section: Introductionmentioning

confidence: 99%

The Hidden Burden of Community Enteral Feeding on the Emergency Department

Barrett

Merrick

et al. 2020

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…[1] However, previous studies have reported some probable complications such as wound infection, tube dislodgement, peristomal leakage, bleeding, internal organ injury, necrotizing fasciitis, and aspiration pneumonia. [2,3] Most complications are minor, but some rare severe complications may be life threatening. Gastrocolocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG).…”

Section: Introductionmentioning

confidence: 99%

Gastrocolocutaneous Fistula: An Unusual Complication of Percutaneous Endoscopic Gastrostomy

Acar¹

2019

Laparosc Endosc Surg Sci

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Gastrocolocutaneous fistula is a rare potential complication of percutaneous endoscopic gastrostomy (PEG). This case report is a description of the approach used to manage a gastrocolocutaneous fistula that developed after a PEG procedure. A 35-year-old male with amyotrophic lateral sclerosis had a PEG tube inserted in the endoscopy unit due to recurrent episodes of aspiration pneumonia. During the postoperative period, the PEG tube was withdrawn as a result of bilious discharge from the rim of the tube and maceration of the skin around the tube The patient was referred to us due to the leakage of feces from the PEG site. Given the high rate of flow observed during follow-up and the unlikelihood of spontaneous closure, surgical repair was planned. The operation included repair of a fistula between the stomach and the colon, partial gastric resection, and primary sutures to effect a repair of the colon. Proper management of complications of a PEG procedure can lead to a quick and effective recovery.

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Long-Term Gastrocolocutaneous Fistula after Endoscopic Gastrostomy: How Concerned Should We Be?

Nunes

Oliveira

Cruz

et al. 2019

GE Port J Gastroenterol

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Percutaneous endoscopic gastrostomy (PEG) is a safe technique for long-term enteral feeding. The most common PEG-associated adverse events are minor. Gastrocolocutaneous fistula (GCCF) results from misplacement of the PEG tube through the colon. The importance of this complication is not currently defined, and there is no clearly established therapeutic algorithm. The authors report a series of 3 cases of GCCF diagnosed and treated in a tertiary center. Case 1: An 88-year-old man underwent PEG due to head and neck cancer. The procedure was uneventful, and the patient remained asymptomatic. After the first PEG tube substitution performed at 6 months, stool drainage through the stoma was observed. Computed tomography (CT) showed a GCCF. After tube removal, the fistula spontaneously closed, and the patient remained under nasogastric feeding until death. Case 2: A 31-year-old man with hereditary spastic paraplegia was submitted to PEG without early complications. The patient remained asymptomatic, and 7 months later, replacement of the PEG tube was planned. Under endoscopic control, the primary tube was removed, but the balloon replacement tube, introduced through the skin, was not observed in the gastric lumen. CT displayed a GCCF that spontaneously closed after a few days. A combined laparoscopic and endoscopic approach was used to resect the fistula tracts and perform a new gastrostomy. Case 3: A 45-year-old man with cerebral palsy was referred to PEG. Skin transillumination was only observed transiently, and the abdominal puncture was performed obliquely. The patient remained asymptomatic until the 7th month, when the primary PEG tube replacement was performed. The percutaneously placed substitution tube did not reach the stomach. GCCF was evident on CT. The fistula spontaneously closed, and the patient was referred to elective surgery for laparoscopic gastrostomy. GCCF is an uncommon complication of PEG. Its clinical course seems to be benign with patients remaining asymptomatic under ambulatory enteral feeding for long periods until PEG tube replacement. Spontaneous fistula closure is the rule in this setting. Laparoscopic gastrostomy should be considered when a new PEG is advised and cannot be safely performed due to colon interposition.

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Gastrocolocutaneous fistula: An undetected complication of colon transfixation during percutaneous endoscopic gastrostomy

Cited by 6 publications

References 5 publications

The Hidden Burden of Community Enteral Feeding on the Emergency Department

The Hidden Burden of Community Enteral Feeding on the Emergency Department

Gastrocolocutaneous Fistula: An Unusual Complication of Percutaneous Endoscopic Gastrostomy

Long-Term Gastrocolocutaneous Fistula after Endoscopic Gastrostomy: How Concerned Should We Be?

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