Transcolonic misplacement as a rare complication associated with PEG tube

Abstract

PEG tube placement is a relatively safe procedure; however, complications sometimes occur. Our article will allow readers to visualize the uncommon complication of PEG ‐ a transcolonic misplacement.

Transcolonic misplacement is a rare complication associated with PEG tube. Surgical or endoscopic removal of misplaced PEG tube is recommended.

1. CASE DESCRIPTION

An 84‐year male patient with a past medical history of coronary artery disease, heart failure with preserved ejection fraction, hypertension, and chronic dysphagia status post percutaneous gastrostomy tube (PEG) placement presented for worsening hemoglobin levels on laboratories. The patient was asymptomatic on admission.

The patient denied any melena, hematochezia, diarrhea, constipation, vomiting, hematemesis, and abdominal pain. His hemoglobin was 7 (reference range 13.8–17.2) g/dL on admission; therefore, he received 1 unit of packed red blood cells. The patient was scheduled for colonoscopy because of suspicion of iron deficiency anemia secondary to chronic blood loss. The total procedure time of colonoscopy was 92 min due to dense diverticular disease in the left colon, extremely difficult cecal intubation, and a large polyp in a difficult/unstable position, requiring scope exchange for completion of polypectomy. PEG tube shaft was noted going through the transverse colon (Figure 1). The PEG tube was placed 6 months prior to colonoscopy. Gastrocolic fistula was diagnosed clinically and confirmed on the CT scan of the abdomen. The definitive treatment for misplaced PEG tube includes surgical removal or endoscopic removal of PEG tube; however, the patient refused any further interventions.

FIGURE 1.

Endoscopy image showing misplaced PEG tube in the transverse colon of an 84‐year‐old male patient

2. DISCUSSION AND CONCLUSION

PEG is a favorable route of feeding and nutritional support in patients with a functional gastrointestinal system who require long term enteral nutrition, generally beyond 4 weeks. Feeding tubes designed for long term include gastrostomy tubes, gastro‐jejunostomy tubes, and jejunostomy tubes. PEG tube is typically placed by preoral push or preoral pull techniques. As PEG tube provides direct percutaneous access to the stomach, another indication for PEG placement includes stomach decompression. ¹ PEG tube placement is a relatively safe procedure; however, complications sometimes occur. This case illustrates the rare instance of tube misplacement through the transverse colon associated with PEG. Adequate air insufflation of the stomach prevents this complication by displacing the colon away from the path of the PEG tube. Early recognition and management are required to prevent disastrous complications related to a malposition of the PEG tube. Percutaneous removal of the tube may result in stercoral peritonitis or colocutaneous fistula. Therefore, it is recommended to have surgical or endoscopic removal of PEG tube, given the risk of complications associated with percutaneous removal. ²

AUTHOR CONTRIBUTIONS

Marko Kozyk wrote the manuscript. Kateryna Strubchevska reviewed and edited the manuscript. Mihaela Batke contributed to the management of the patient. All authors gave written consent for publication.

CONFLICT OF INTEREST

None.

ETHICAL APPROVAL

The present study conforms to the ethical standards and guidelines of the journal.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Kozyk M, Strubchevska K, Batke M. Transcolonic misplacement as a rare complication associated with PEG tube. Clin Case Rep. 2022;10:e06650. doi: 10.1002/ccr3.6650

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.