A Case of an Infant who Developed Duodenocolonic Penetration as a Complication of Percutaneous Endoscopic Gastrostomy Catheter With Jejunal Extension

Abstract

The percutaneous endoscopic gastrostomy catheter with jejunal extension (PEG-J catheter) is available in small sizes. However, there are no established standards for these sizes and their indications for use in small children. We herein report a complication of penetration from the duodenum to the colon in a 1-year-old, 7.3-kg infant with a 16Fr 400-mm PEG-J catheter placed via a gastrostomy. Two months after placement, the distal end of the catheter prolapsed through the anus. A contrast-enhanced computed tomography revealed the penetration of the duodenum and the colon by the catheter. The penetration was diagnosed as being caused by the continuous compression of the duodenal wall at the horizontal portion of the duodenum by the end of the catheter from the time of placement. After the nonsurgical removal of the catheter followed by medical treatment for two weeks, a gastrointestinal examination confirmed that the fistula was functionally closed. Indications for the size of the PEG-J catheter to be placed in small children should be carefully discussed on the basis of the patient’s body size and device specifications. Tube enterostomy should also be considered, particularly in children weighing less than 10 kg, and close monitoring is necessary to detect intestinal perforation. In addition, stabilized fistulas can be expected to close functionally without surgical intervention.