title: Misplacement of percutaneously inserted gastrostomy tube into the colon: report of 6 cases and review of the literature.
abstract: BACKGROUND
  With the increasing use of percutaneous endoscopic gastrostomy (PEG), rare complications are seen; one of them is misplacement of the tube into the colon. We describe the various clinical pictures and treatment approaches.
  
  
  METHODS
  Case series from our hospital and case reports from the literature are presented. Symptoms, time interval from symptoms to diagnosis, time elapsed from initial PEG insertion to replacement or to regression, regression of gastrostomy tube to the colon vs colonic placement of reinserted tube, and treatment approaches are evaluated.
  
  
  RESULTS
  We identified and studied 6 patients in our hospital who had misplacement of a PEG into the colon. A review of the English literature revealed another 22 adult cases with this complication. Of the total 28 cases, 8 had previous abdominal pathology. Seventeen patients developed symptoms after tube replacement, whereas in 11 the tube had not been changed. Fourteen had diarrhea, 11 presented with fecal discharge in or around the tube, and 3 were asymptomatic. Thirteen showed colocutaneous fistula without residual connection to the stomach. Ten patients were treated surgically and 14 conservatively by removal of the tube. One patient had colonoscopic clipping of the fistula.
  
  
  CONCLUSIONS
  Gastroenterologists should adhere strictly to cautionary measures to prevent misplacement of PEG into the colon. In patients with PEG feeding, the clinician should suspect misplacement of the tube into the colon when there is recurrent severe diarrhea of undigested food or fecal content in the tube, particularly after tube replacement. Treatment may be conservative in most cases.
authors.affiliation: Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. reufri@yahoo.com
authors.forename: Reuven
authors.initials: R
authors.lastname: Friedmann
authors.forename: Helena
authors.initials: H
authors.lastname: Feldman
authors.forename: Moshe
authors.initials: M
authors.lastname: Sonnenblick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000592:standards; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome