Misplacement of Percutaneously Inserted Gastrostomy Tube Into the Colon: Report of 6 Cases and Review of the Literature

Abstract

Gastroenterologists should adhere strictly to cautionary measures to prevent misplacement of PEG into the colon. In patients with PEG feeding, the clinician should suspect misplacement of the tube into the colon when there is recurrent severe diarrhea of undigested food or fecal content in the tube, particularly after tube replacement. Treatment may be conservative in most cases.

Wandering Gastrostomy

“…PEG malposition can occur acutely while inserting the tube or as a result of chronicity [1]. Colonic misplacement of the PEG tube may lead to serious complications, in particular the development of gastrocolic, colocutaneous, or gastrocolocutaneous fistulae [2]. Its probable etiology is the penetration of a bowel loop (mostly the transverse colon) interposed between the stomach and the abdominal wall, either by inadvertent puncture during tube placement or, more commonly, due to gradual erosion of the tube into the adjacent bowel [3].…”

“…The most common clinical symptoms associated with fistulae are watery diarrhea containing feed, or the presence of stool around the PEG tube. Rarely, fistulae present acutely with peritonitis, infection, fasciitis, or failure of the formula infusion [2]. A combination of endoscopy, contrast study through the PEG tube, and the CECT abdomen would help in the diagnosis of PEG malposition.…”

“…Colonoscopy verifies position of the hub in the colon contrast study of the gastrostomy tube by injecting gastrograffin in the tube and taking plain abdominal X-ray, or doing fluoroscopy will show the position of the hub and any extravasation of the contrast into the peritoneal cavity [1]. Quite a few cases of colocutaneous fistula have been reported in the literature [5]. Several approaches have been suggested for fistula management, ranging from conservative removal of the PEG tubes without laparotomy, hereby allowing the fistula tract to close spontaneously within a few days, to invasive exploration of the colon.…”

Acute Buried Bumper Syndrome with Gastric Perforation and Peritonitis: A Rare Complication of Percutaneous Endoscopic Gastrostomy: Case Report

“…Other rare complications are peritonitis, gastrocolocutaneous fistula, aspiration pneumonia and buried bumper syndrome. [3][4][5][6][7] Buried bumper syndrome is an uncommon but serious complication of PEG with an incidence of 1.97%. 8 It occurs when the internal bumper of the PEG tube migrates and becomes lodged between the gastric wall and the skin along the PEG tube tract.…”

“…20 Endoscopic clipping can also be used successfully to repair perforations in gastrointestinal system although immediate surgical intervention is the traditional treatment of choice. 1,7,[21][22][23] Gastric perforation is mostly seen in cases where displacement of PEG tube occurs before fistula tract formation. We think that pressure necrosis due to excessive tension between the bumpers before formation of fistula tract is the main contributing factor in our case.…”