Blashinsky Zachary A, Calafell Joel A
Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
General Surgery, Baptist Health South Florida, Miami, USA.
Cureus. 2024 Jul 5;16(7):e63908. doi: 10.7759/cureus.63908. eCollection 2024 Jul.
Percutaneous endoscopic gastrostomy (PEG) is a common technique for enteral nutrition support. Complications range from skin injuries and leakage to more severe intraabdominal pathologies. This case report describes a patient with invasive right lateral pharyngeal wall squamous cell carcinoma who developed a gastrocolocutaneous fistula following PEG tube malpositioning in the transverse colon performed at an outside institution. Based on the patient's comorbidities and the associated high-risk nature of the surgery, a transverse colectomy and partial gastrectomy to resect the malpositioned tube followed by a new PEG tube was deemed invasive and would likely have a poor clinical outcome. Instead, the surgeon performed a laparoscopic-assisted PEG tube insertion in another portion of the stomach. The fistulous tract of the original PEG tube was completely sealed and fell out one week following surgery. The patient tolerated feeds through the new PEG tube site. Gastrocolocutaneous fistulas are rare complications of PEG tube insertion with a poorly understood pathophysiology. Here, we analyze the root cause of this condition, steps to mitigate it, and a proposed novel surgical approach for its conservative management.
经皮内镜下胃造口术（PEG）是肠内营养支持的常用技术。并发症范围从皮肤损伤和渗漏到更严重的腹腔内病变。本病例报告描述了一名患有侵袭性右侧咽壁鳞状细胞癌的患者，在外部机构进行的PEG管误置于横结肠后发生了胃结肠皮肤瘘。基于患者的合并症以及手术相关的高风险性质，切除误置管的横结肠切除术和部分胃切除术，随后再插入一根新的PEG管被认为具有侵入性，并且临床结果可能不佳。相反，外科医生在胃的另一部位进行了腹腔镜辅助PEG管插入术。原PEG管的瘘道完全封闭，术后一周自行脱落。患者通过新的PEG管部位耐受喂养。胃结肠皮肤瘘是PEG管插入术罕见的并发症，其病理生理学尚不清楚。在此，我们分析了这种情况的根本原因、缓解措施以及一种用于保守治疗的新型手术方法。
