VM18 - Laparoscopic Repair of Colotomy Following Mispositioned Percutaneous Endoscopic Gastrostomy (PEG) Insertion

Saturday, June 1, 2024

10:00 AM – 1:30 PM ET, USA

Location: Baltimore Convention Center, Hall BCD

Video Presentation(s)

Woi Kim, MD

Fellow
University of Texas Health Science Center at Houston
University of Texas Houston Colorectal Surgery
Houston, TX, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

SN

Shiraz Naqvi, MD

Resident
University of Texas Houston Department of Surgery
Houston, Texas, United States

Disclosure information not submitted.
AS

Areeba Saif, MD

Resident
University of Texas Houston Department of Surgery
Houston, Texas, United States

Disclosure information not submitted.
AA

Amit Agarwal, MD

Associate Professor
University of Texas Houston Colorectal Surgery
Houston, Texas, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

SS

Shinil K. Shah, DO, EdD

Associate Professor
UT Health McGovern Medical School
Houston, Texas, United States

Disclosure information not submitted.

Purpose/Background: The Percutaneous Endoscopic Gastrostomy (PEG) procedure is commonly performed to provide an alternate route of nutrition, nutrition supplementation, or gastric decompression. A rare ( < 1%) complication is misplacement through or into the colonic lumen resulting in a gastrocolic fistula. Mortality rates can be as high as 20% given the largely frail patient population that requires PEG procedures.

Methods/Interventions: We report the case of a severely intellectually disabled and facility dependent 74-year-old male who underwent a PEG placement for malnutrition and impaired self-feeding. The gastroenterologist performed the PEG insertion with direct visualization under esophagogastroduodenoscopy (EGD) and “pull” technique. Two months later the patient was admitted for fungemia. During the hospitalization persistent tube feed leakage around the peri-gastrostomy skin prompted a contrast tube study that revealed positioning in the lumen of the transverse colon. This was likely due to chronic erosion into the colon after initial gastrocolic placement. Laparoscopically the colotomy was repaired primarily, and a new gastrostomy tube was placed with EGD and laparoscopic visualization.

Results/Outcomes: Our patient was clinically well in the immediate postoperative period, but unfortunately had an aspiration event on postoperative day six which led to cardiopulmonary arrest and death despite cardiopulmonary resuscitation efforts.

Conclusion/Discussion: Colotomies are rare but reported complications of PEG tube insertions. Nonoperative, endoscopic, and surgical repairs have been described. Surgical treatment can be uncomplicated but should be carefully considered in the context of the patient’s clinical status.