A New Method for Endoscopic Closure of Gastrocolonic Fistula

An 82-year-old woman underwent what was thought to be uneventful PEG tube placement. One year later she presented with diarrhea and feculent vomiting. A CT scan revealed a 1.5 cm gastrocolic fistula tract – and the internal bumper of the feeding tube in the distal transverse colon (Figure 1). Presumably, at the time of G-tube placement, the feeding tube was inadvertently inserted into the stomach through the transverse colon and, over time, the internal bumper eroded through the matured fistula tract and into the colon. The patient was scheduled for surgical repair but developed cardiopulmonary compromise thought to pose an unacceptable peri-operative risk. She was placed on total parenteral nutrition, but had repeated metabolic and infectious complications.