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DOI: 10.1055/a-2358-1166
Profuse diarrhea after percutaneous change of a computed tomography-guided gastrostomy: endoscopic closure of a colocutaneous fistula
A 71-year-old patient was admitted after the accidental dislodgement of a computed tomography (CT)-guided percutaneous gastrostomy, placed 1 year prior. The initial procedure was uneventful and facilitated rapid weight gain. A percutaneous MIC-KEY tube (Avanos, Alpharetta, Georgia, USA) was rapidly placed along the previous route. As soon as nutrition was restarted, “on and off” profuse diarrhea occurred, ceasing as the nutrition was stopped and resuming immediately upon resumption. Opacification of the MIC-KEY tube revealed a fistulous tract between the transverse colon and the skin ([Video 1]). Conservative treatment was decided, involving the endoscopic closure of the residual colocutaneous fistula, achieved by placing an Ovesco clip (Ovesco Endoscopy, Tübingen, Germany) during a colonoscopy [1].
Quality:
In conclusion, a transcolonic perforation may go unnoticed during the months [2] after a CT-guided percutaneous gastrostomy. Colocutaneous fistulous tract can be safely closed using an Ovesco clip during a colonoscopy [1] [3], to avoid the need for surgery.
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Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgement
We address our acknowledgments to Mr. Charles Duboc for the creation of the animated graphic illustrations.
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References
- 1 Rodrigues-Pinto E, Santos AL, Macedo G. Endoscopic closure of a colocutaneous fistula after placement of percutaneous endoscopic gastrostomy. Endoscopy 2020; 52: 187-188 DOI: 10.1055/a-1063-6276. (PMID: 31816655)
- 2 Van Gossum A, DesMarez B, Cremer M. A colo-cutaneous-gastric fistula: a silent and unusual complication of percutaneous endoscopic gastrostomy. Endoscopy 1988; 20: 161 DOI: 10.1055/s-2007-1018166. (PMID: 3181089)
- 3 Friedmann R, Feldman H, Sonnenblick M. Misplacement of percutaneously inserted gastrostomy tube into the colon: report of 6 cases and review of the literature. JPEN J Parenter Enteral Nutr 2007; 31: 469-476 DOI: 10.1177/0148607107031006469. (PMID: 17947601)
Correspondence
Publication History
Article published online:
08 July 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Rodrigues-Pinto E, Santos AL, Macedo G. Endoscopic closure of a colocutaneous fistula after placement of percutaneous endoscopic gastrostomy. Endoscopy 2020; 52: 187-188 DOI: 10.1055/a-1063-6276. (PMID: 31816655)
- 2 Van Gossum A, DesMarez B, Cremer M. A colo-cutaneous-gastric fistula: a silent and unusual complication of percutaneous endoscopic gastrostomy. Endoscopy 1988; 20: 161 DOI: 10.1055/s-2007-1018166. (PMID: 3181089)
- 3 Friedmann R, Feldman H, Sonnenblick M. Misplacement of percutaneously inserted gastrostomy tube into the colon: report of 6 cases and review of the literature. JPEN J Parenter Enteral Nutr 2007; 31: 469-476 DOI: 10.1177/0148607107031006469. (PMID: 17947601)