Introduction

Percutaneous endoscopic gastrostomy (PEG) placement is a common procedure for patients requiring non-oral feeding.  One rare complication of PEG placement is the formation of a gastrocolocutaneous fistula that develops when bowel is caught between the stomach and abdominal wall during placement.  This report explores an elderly patient's gastrocolocutaneous fistula development months post-PEG placement who presented with malodorous leakage from the gastrostomy tube to the Emergency Department (ED).

Case Report

A 73-year-old male on hospice presented to the ED with malodorous leakage from his PEG tube.  He had received the PEG tube four months prior to this presentation and had it replaced once at an outside hospital due to blockages.  In the ED, his PEG tube was found to have a deflated balloon stopper.  The PEG tube was replaced, but the feculent discharge persisted.  Imaging showed the tube's position in the transverse colon.  The patient underwent non-surgical management, with PEG tube removal and nutritional support via nasogastric tube.  He was discharged with improvement of PEG site. 

Conclusion

Gastrocolocutaneous fistula should be considered in patients experiencing unexpected PEG tube drainage or feeding-related complications such as diarrhea.  Careful replacement techniques after dislodgement or blockage are important.  Radiologic confirmation should be considered after replacement of tubes with feculent drainage.  The rarity of gastrocolocutaneous fistula cases in literature explains the lack of standardized management approaches.  Clinical signs such as feculent leakage through PEG tube site should prompt recognition and diagnosis by the ED clinician.