Nunes Gonçalo, Paiva de Oliveira Gabriel, Cruz João, Santos Carla Adriana, Fonseca Jorge
Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal.
Surgery Department, Hospital Garcia de Orta, Almada, Portugal.
GE Port J Gastroenterol. 2019 Oct;26(6):441-447. doi: 10.1159/000497248. Epub 2019 Apr 3.
Percutaneous endoscopic gastrostomy (PEG) is a safe technique for long-term enteral feeding. The most common PEG-associated adverse events are minor. Gastrocolocutaneous fistula (GCCF) results from misplacement of the PEG tube through the colon. The importance of this complication is not currently defined, and there is no clearly established therapeutic algorithm. The authors report a series of 3 cases of GCCF diagnosed and treated in a tertiary center.
CASE 1: An 88-year-old man underwent PEG due to head and neck cancer. The procedure was uneventful, and the patient remained asymptomatic. After the first PEG tube substitution performed at 6 months, stool drainage through the stoma was observed. Computed tomography (CT) showed a GCCF. After tube removal, the fistula spontaneously closed, and the patient remained under nasogastric feeding until death.
CASE 2: A 31-year-old man with hereditary spastic paraplegia was submitted to PEG without early complications. The patient remained asymptomatic, and 7 months later, replacement of the PEG tube was planned. Under endoscopic control, the primary tube was removed, but the balloon replacement tube, introduced through the skin, was not observed in the gastric lumen. CT displayed a GCCF that spontaneously closed after a few days. A combined laparoscopic and endoscopic approach was used to resect the fistula tracts and perform a new gastrostomy.
CASE 3: A 45-year-old man with cerebral palsy was referred to PEG. Skin transillumination was only observed transiently, and the abdominal puncture was performed obliquely. The patient remained asymptomatic until the 7th month, when the primary PEG tube replacement was performed. The percutaneously placed substitution tube did not reach the stomach. GCCF was evident on CT. The fistula spontaneously closed, and the patient was referred to elective surgery for laparoscopic gastrostomy. GCCF is an uncommon complication of PEG. Its clinical course seems to be benign with patients remaining asymptomatic under ambulatory enteral feeding for long periods until PEG tube replacement. Spontaneous fistula closure is the rule in this setting. Laparoscopic gastrostomy should be considered when a new PEG is advised and cannot be safely performed due to colon interposition.
经皮内镜下胃造口术（PEG）是一种用于长期肠内营养的安全技术。最常见的与PEG相关的不良事件较为轻微。胃结肠皮肤瘘（GCCF）是由于PEG管误置入结肠所致。目前尚未明确这种并发症的重要性，也没有明确确立的治疗方案。作者报告了在一家三级中心诊断和治疗的3例GCCF病例。
病例1：一名88岁男性因头颈癌接受PEG手术。手术过程顺利，患者无症状。在6个月时进行首次PEG管更换后，观察到造口有粪便排出。计算机断层扫描（CT）显示有GCCF。拔除管子后，瘘口自行闭合，患者在鼻饲喂养下直至死亡。
病例2：一名31岁患有遗传性痉挛性截瘫的男性接受PEG手术，早期无并发症。患者无症状，7个月后计划更换PEG管。在内镜控制下，拔除了原管，但经皮肤置入的球囊更换管未在胃腔内见到。CT显示有GCCF，几天后自行闭合。采用腹腔镜和内镜联合方法切除瘘道并进行新的胃造口术。
病例3：一名45岁患有脑瘫的男性接受PEG手术。仅短暂观察到皮肤透照，腹部穿刺为斜行。患者在第7个月进行原PEG管更换前一直无症状。经皮置入的更换管未进入胃内。CT显示有明显的GCCF。瘘口自行闭合，患者被转诊至择期手术进行腹腔镜胃造口术。GCCF是PEG的一种罕见并发症。其临床过程似乎是良性的，患者在长期非卧床肠内营养下无症状，直到PEG管更换。在这种情况下，瘘口自行闭合是常见的。当建议进行新的PEG手术但由于结肠介入而无法安全进行时，应考虑腹腔镜胃造口术。
