Gastrointestinal: PEG feeding tube migration into the colon; a late manifestation

Lenzen, Henrike; Weismüller, Tobias J.; Bredt, M.; Bahr, Matthias J.

doi:10.1111/j.1440-1746.2012.07157.x

Cited by 10 publications

(7 citation statements)

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“…Several cases have highlighted PEG tube migration - to the pylorus, duodenum, ileocecal valve, and even to the transverse colon in the setting of a gastrocolic fistula. [3] , [4] , [5] , [6] , [7] , [8] Among these cases, some patients were notably asymptomatic, similar to the patient presented in this case. In other reports, patients demonstrated abdominal cramping, pain, diarrhea, or non-bilious vomiting.…”

Section: Discussionsupporting

confidence: 70%

Missing PEG tube found at the ileocecal valve

Kondaveety

Bailey

Blackwood

et al. 2021

Radiology Case Reports

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Percutaneous endoscopic gastrostomy (PEG) tubes are indicated in cases of oropharyngeal or esophageal dysphagia to allow alimentation. Complications are superficial and minor, however obstruction in the setting of PEG migration has been noted. Most obstructions remain proximal, localized to the pyloric or pre-pyloric region, though distal migration to the large intestine, including the cecum, have been noted. Here we present a case of an elderly gentleman with advanced dementia complicated by oropharyngeal dysphagia who presented in the context of a missing PEG tube without adjunctive symptoms. Initial imaging and Esophagogastroduodenoscopy were unremarkable and a repeat PEG tube was placed. Thereafter, repeat imaging demonstrated an oval-shaped foreign object within the right lower quadrant concerning for a migrated original PEG tube, which was confirmed by Computed Tomography with migration to the ileocecal valve. Colonoscopy was subsequently performed with PEG tube retrieval. This case highlights the need to maintain a high index of suspicion for distal PEG tube migration even in the absence of overt symptomatology to prevent further complications such as small or large bowel obstruction.

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Section: Discussionsupporting

confidence: 70%

Missing PEG tube found at the ileocecal valve

Kondaveety

Bailey

Blackwood

et al. 2021

Radiology Case Reports

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“…The symptom of diarrhea with food content which occurs after the symptomatic period should be a warning in respect of gastrocolocutaneous fistula in patients with PEG. The onset of diarrhea and abdominal pain in the form of cramp immediately after tube feeding, the odour of faces from the stoma and fecaloid vomiting are other symtoms which may be seen [5][6][7][8][9][10][11][12][13][14][15]. In contrast to the information in literature, there was no complaint of diarrhea in the current case, but there was obstruction.…”

Section: Discussioncontrasting

confidence: 65%

Gastrocolocutaneous Fistula Following Percutaneous Endoscopic Gastrostomy in an Octogenerian Patient

Gökakın¹

2018

GGS

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“…7 In cases of intracolonic migration, characteristic symptoms such as the sudden onset of diarrhea and cramping immediately after tube feeding, an odorous fecal exudate from the stoma, and loosening of the tube appear. 6 In addition to these symptoms, a long bowel preparation period, which was approximately 1 week in Case 1, may be associated with the intracolonic migration of the bumper of the feeding tube.…”

Section: Discussionmentioning

confidence: 97%

“…Patients with this complication can remain without typical symptoms for a long time, and several cases with long asymptomatic periods have been reported. 5 , 6 , 7 , 8 Therefore, awareness is helpful to avoid this complication, and a high index of suspicion can ensure an early diagnosis. Herein, we report 2 cases of iatrogenic gastrocolocutaneous fistula following PEG presenting after a long asymptomatic period.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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Gastrocolocutaneous fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) procedure. Typical symptoms usually occur in the first few months. We recently encountered 2 patients with 8- and 33-month asymptomatic periods. A 74-year-old man presented with watery diarrhea for 1 month. He had undergone PEG 9 months earlier. During workup, an upper endoscopy and abdominal CT scan revealed the migration of the feeding tube into the transverse colon. He was discharged with a nasogastric tube after treatment. A 77-year-old man presented with sudden loosening of his PEG tube with a duration over 3 days. He had undergone PEG procedure three times until that time. During workup, a gastrocolocutaneous fistula was diagnosed. However, when previous studies were reviewed, an abdominal CT scan, which was done 6 months ago before the third PEG, showed the fistula already existed at that time, suggesting that it was created about 33 months earlier when he underwent the second PEG procedure. The patient died of pneumonia aggravation despite conservative treatment. Both a high index of suspicion and the careful inspection of the upper endoscopy are very important for early diagnosis regardless of symptoms.

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Gastrointestinal: PEG feeding tube migration into the colon; a late manifestation

Cited by 10 publications

References 0 publications

Missing PEG tube found at the ileocecal valve

Missing PEG tube found at the ileocecal valve

Gastrocolocutaneous Fistula Following Percutaneous Endoscopic Gastrostomy in an Octogenerian Patient

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

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