Gastrocolocutaneous Fistula due to Percutaneous Endoscopic Gastrostomy Placement

An 84-year-old woman with vascular dementia and percutaneous endoscopic gastrostomy (PEG) placement 2 months prior presented with a fecal odor from the PEG tube and diarrhea at each feeding. No feces output from the PEG tube or peristomal leakage was noted. Computed tomography of the abdomen showed penetration of the PEG tube through the transverse colon to the stomach, without surrounding inflammatory changes (Picture 1, 2). She was diagnosed with gastrocolocutaneous fistula due to an inaccurate PEG placement. The PEG tube was removed. After receiving parenteral nutrition for two weeks, upper endoscopy confirmed the closure of the fistula on the gastric mucosa. The patient was subsequently placed on nasogastric feeding. Gastrocolocutaneous fistula is a rare complication of PEG placement, and persistent diarrhea on feeding is a common symptom (1, 2). Treatment includes the removal of the PEG tube and occasionally excision of the fistula (1, 2). PEG feeding is not always safe, and its indications should thus be carefully considered.