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Misplacement of Percutaneously Inserted Gastrostomy Tube Into the Colon: Report of 6 Cases and Review of the Literature

Reuven Friedmann, MD^*,, Helena Feldman, MD^* and Moshe Sonnenblick, MD^*

From the ^* Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; and the "Neve Horim" Home for the Aged, Jerusalem, Israel

Correspondence: Reuven Friedmann, MD, Geriatric Department, Shaare Zedek Medical Center, POB 3235, Jerusalem, 91031, Israel. Electronic mail may be sent to reufri{at}yahoo.com.

Background: With the increasing use of percutaneous endoscopic gastrostomy (PEG), rare complications are seen; one of them is misplacement of the tube into the colon. We describe the various clinical pictures and treatment approaches. Methods: Case series from our hospital and case reports from the literature are presented. Symptoms, time interval from symptoms to diagnosis, time elapsed from initial PEG insertion to replacement or to regression, regression of gastrostomy tube to the colon vs colonic placement of reinserted tube, and treatment approaches are evaluated. Results: We identified and studied 6 patients in our hospital who had misplacement of a PEG into the colon. A review of the English literature revealed another 22 adult cases with this complication. Of the total 28 cases, 8 had previous abdominal pathology. Seventeen patients developed symptoms after tube replacement, whereas in 11 the tube had not been changed. Fourteen had diarrhea, 11 presented with fecal discharge in or around the tube, and 3 were asymptomatic. Thirteen showed colocutaneous fistula without residual connection to the stomach. Ten patients were treated surgically and 14 conservatively by removal of the tube. One patient had colonoscopic clipping of the fistula. Conclusions: Gastroenterologists should adhere strictly to cautionary measures to prevent misplacement of PEG into the colon. In patients with PEG feeding, the clinician should suspect misplacement of the tube into the colon when there is recurrent severe diarrhea of undigested food or fecal content in the tube, particularly after tube replacement. Treatment may be conservative in most cases.

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