Colocutaneous fistula after a PEG - 23/08/11
Doi : 10.1016/j.gie.2008.03.1067
| Commentary A colocutaneous fistula is a rare complication of PEG placement that occurs as a result of the interposition of the colon between the anterior abdominal and gastric walls. The tube either is placed through the colon into the stomach and migrates back into the colon over time, as it likely did in this case, or insertion is directly into the colon. In the former case, patients usually are asymptomatic, although they may develop a transient fever or ileus. The problem is discovered when the original tube is removed and a replacement tube (usually passed blindly at the bedside) is inserted into the colon and cannot be negotiated through the tract back into the stomach. With direct passage, diarrhea occurs immediately upon feeding when formula is instilled into the colon. Prevention of this complication is by using proper technique: relying on both transillumination and finger palpation to choose an appropriate site. In questionable situations, use of a fluid-filled syringe attached to a “probing” needle may allow a bolus of gas to be suctioned into the syringe before the needle is identified in the stomach, thus suggesting passage into another hollow viscus. With all due respect to Dante, it is not necessary to abandon all hope once ye enter here, just recognize the problem, think about how it occurred, and do it better the next time. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 68 - N° 4
P. 770 - octobre 2008 Retour au numéro
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