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

Overview

Journal Clin Endosc

Date 2017 Sep 1

PMID 28854775

Citations 8

Authors

Junghwan Lee

Jinyoung Kim

Ha Il Kim

Chung Ryul Oh

Sungim Choi

Soomin Noh

Hee Kyong Na

Hwoon-Yong Jung

Affiliations

Soon will be listed here.

Abstract

A gastrocolocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG). We report a case of a gastrocolocutaneous fistula presenting with intractable diarrhea and gastrostomy tube malfunction. A 62-year-old woman with a history of multiple system atrophy was referred to us because of PEG tube malfunction. Twenty days prior to presentation, the patient started developing sudden diarrhea within minutes after starting PEG feeding. Fluoroscopy revealed that the balloon of the PEG tube was located in the lumen of the transverse colon with the contrast material filling the colon. Subsequently, the PEG tube was removed and the opening of the gastric site was endoscopically closed using hemoclips. Clinicians should be aware of gastrocolocutaneous fistula as one of the complications of PEG insertion. Sudden onset of diarrhea, immediately after PEG feedings, might suggest this complication, which can be effectively treated with endoscopic closure.

Citing Articles

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References

Friedmann R, Feldman H, Sonnenblick M . Misplacement of percutaneously inserted gastrostomy tube into the colon: report of 6 cases and review of the literature. JPEN J Parenter Enteral Nutr. 2007; 31(6):469-76. DOI: 10.1177/0148607107031006469. View

Tominaga K, Saigusa Y, Ito S, Hirahata K, Nemoto Y, Maetani I . Percutaneous endoscopic gastrostomy with the aid of a colonoscope to avoid gastrocolic fistula formation. Endoscopy. 2007; 39 Suppl 1:E112-3. DOI: 10.1055/s-2007-966106. View

Huang S, Levine M, Raper S . Gastrocolic fistula with migration of feeding tube into transverse colon as a complication of percutaneous endoscopic gastrostomy. AJR Am J Roentgenol. 2005; 184(3 Suppl):S65-6. DOI: 10.2214/ajr.184.3_supplement.01840s65. View

Kim H, Lee D, Baik S, Kwon S . Endoscopic management of colocutaneous fistula after percutaneous endoscopic gastrostomy. Endoscopy. 2002; 34(5):430. DOI: 10.1055/s-2002-25284. View

Pitsinis V, Roberts P . Gastrocolic fistula as a complication of percutaneous endoscopic gastrostomy. Eur J Clin Nutr. 2003; 57(7):876-8. DOI: 10.1038/sj.ejcn.1601687. View

Minocha A, Rupp T, Jaggers T, Rahal P . Silent colo-gastrocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1994; 89(12):2243-4. View

Kim H, Bang C, Kim Y, Kwon O, Park M, Eom J . Two cases of gastrocolocutaneous fistula with a long asymptomatic period after percutaneous endoscopic gastrostomy. Intest Res. 2014; 12(3):251-5. PMC: 4204721. DOI: 10.5217/ir.2014.12.3.251. View

Croaker , Najmaldin . Laparoscopically assisted percutaneous endoscopic gastrostomy. Pediatr Surg Int. 1997; 12(2/3):130-1. View

Bertolini R, Meyenberger C, Sulz M . First report of colonoscopic closure of a gastrocolocutaneous PEG migration with over-the-scope-clip-system. World J Gastroenterol. 2014; 20(32):11439-42. PMC: 4145787. DOI: 10.3748/wjg.v20.i32.11439. View

10.

Smyth G, McGreal G, McDermott E . Delayed presentation of a gastric colocutaneous fistula after percutaneous endoscopic gastrostomy. Nutrition. 2003; 19(10):905-6. DOI: 10.1016/s0899-9007(03)00156-4. View

11.

Yamazaki T, Sakai Y, Hatakeyama K, Hoshiyama Y . Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach. Surg Endosc. 1999; 13(3):280-2. DOI: 10.1007/s004649900964. View

12.

Okutani D, Kotani K, Makihara S . A case of gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Acta Med Okayama. 2008; 62(2):135-8. DOI: 10.18926/AMO/30958. View

13.

Strodel W, Lemmer J, Eckhauser F, Botham M, Dent T . Early experience with endoscopic percutaneous gastrostomy. Arch Surg. 1983; 118(4):449-53. DOI: 10.1001/archsurg.1983.01390040059012. View

14.

Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P . Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012; 47(6):737-42. DOI: 10.3109/00365521.2012.654404. View

15.

Melmed G, Kar S, Geft I, Lo S . A new method for endoscopic closure of gastrocolonic fistula: novel application of a cardiac septal defect closure device (with video). Gastrointest Endosc. 2009; 70(3):542-5. DOI: 10.1016/j.gie.2009.03.027. View

16.

Lee H, Choung R, Park M, Pyo J, Kim S, Hyun J . Two cases of uncommon complication during percutaneous endoscopic gastrostomy tube replacement and treatment. Korean J Gastroenterol. 2014; 63(2):120-4. DOI: 10.4166/kjg.2014.63.2.120. View

17.

Hwang J, Kim H, Kang D, Choi C, Park S, Park T . A case of endoscopic treatment for gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Clin Endosc. 2012; 45(1):95-8. PMC: 3363121. DOI: 10.5946/ce.2012.45.1.95. View

18.

Liu S, Ng S, Yip H, Teoh A, Chiu P, Ng E . Migration of a percutaneous endoscopic gastrostomy tube into the transverse colon: a forgotten cause of refractory diarrhea. Endoscopy. 2010; 42 Suppl 2:E324-5. DOI: 10.1055/s-0030-1255703. View

19.

Stefan M, Holcomb 3rd G, Ross 3rd A . Cologastric fistula as a complication of percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr. 1989; 13(5):554-6. DOI: 10.1177/0148607189013005554. View

20.

Hucl T, Spicak J . Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol. 2016; 30(5):769-781. DOI: 10.1016/j.bpg.2016.10.002. View