Laparoscopic Management of a Gastro-Colo-Cutaneous Fistula Following PEG Placement

Zachary F Williams, MD, James W Rawles III, MD, William W Hope, MD. New Hanover Regional Medical Center

Percutaneous endoscopic gastrostomy (PEG) tube placement has become one of the mainstays for enteral nutrition in patients unable to tolerate oral feedings. Complications related to PEG tube placement are typically minor, however, major complications have been reported. One unique complication related to PEG placement involves the placement of the PEG transcolonic. Treatment strategies for managing transcolonic PEG placement vary as it is a rare complication and have not been well studied.

We present a case of an 84 year old male with stage IV laryngeal cancer admitted to the hospital for dysphagia and failure to thrive. Gastroeterology (GI) was consulted for PEG placement and patient underwent and uneventful procedure. Surgery was consulted 1 week post PEG procedure secondary to stool draining around PEG tube and concern for transcolonic PEG. After discussion with GI and secondary to the patient clinical condition the PEG tube was removed and the patient remained stable. Over the next several days the patient continued to drain from abdominal wall and developed a gastro-colo-cutaneous fistula and was unable to obtain alternative enteral access. Surgical options were discussed and the patient underwent laparoscopic takedown of gastro-colo-cutaneous fistula with PEG placement. The patient recovered well as was able to restart enteral feeds.

In this video we discuss the complication of transcolonic PEG, its management, and the surgical management including the technical aspects of laparoscopic takedown

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