NONSURGICAL MANAGEMENT OF COLOCUTANEOUS FISTULA AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: REPORT OF THREE CASES

Abstract

Colocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG). We experienced three cases of colocutaneous fistula after PEG successfully managed without surgical revision. In two cases, colocutaneous fistula were discovered with no signs of peritonitis or obstruction at the time of the PEG tube exchange, three months and nine months after PEG, respectively. After the PEG tubes were removed with total parenteral nutrition and systemic antibiotics treatment for one week, the fistulae healed spontaneously. The former patient underwent repeat PEG with a care to avoid injury to the colon and the latter improved difficulty in swallowing by means of rehabilitation resulting in no need for PEG. In the last case, colocutaneous fistula became apparent at four days after PEG. Fluologram showed the tip of the PEG tube in the transverse colon and a gastrocolic fistula formation without peritoneal leakage. The PEG tube was removed one month after PEG, with total parenteral nutrition and systemic antibiotics treatment and PEG was performed again. In conclusion, conservative management of colocutaneous fistula after PEG is a safe and reliable option in cases without evidence of peritonitis.