title: [The colocutaneous fistula -  a rare complication of percutaneous endoscopic gastrostomy].
abstract: METHODS
  A 43-year-old woman with spastic tetraparesis, mental retardation and long-term tube feeding was admitted for a replacement of the PEG tube, 15 months after placement and regular use of her first feeding tube. New problems had occurred with local infection and a suspected leakage. The gastrostoma showed a local erythema and increased secretion of putrid fluids, furthermore a tendency to diarrhea had developed. Otherwise the abdomen was inconspicuous.
  
  
  METHODS
  All routinely achieved blood tests were normal. Gastroscopy revealed a mucosal scar with a small fistula instead of the expected tip of the PEG tube. A CT scan demonstrated displacement of the tip into the transverse colon.
  
  
  METHODS
  The displaced PEG tube was removed by colonoscopy. After laparoscopic occlusion of the colocutaneous fistula with a surgical stapler and clearing of further adhesions a new PEG was inserted endoscopically during the same operation with laparoscopic guidance through the pneumoperitoneum.
  
  
  CONCLUSIONS
  The development of a colocutaneous fistula as a result of an unperceived perforation is a rare complication of a PEG placement. Despite of the notable mechanism that the tip of the tube erodes the gastric wall and penetrates into the adjacent colon, the clinic is often oligosymptomatic and can easily been missed.
authors.affiliation: Medizinische Klinik, Spital Zollikerberg, 8125 Zollikerberg/Zürich, Schweiz. ludwigtheodor.heuss@spitalzollikerberg.ch
authors.forename: L T
authors.initials: LT
authors.lastname: Heuss
authors.forename: R
authors.initials: R
authors.lastname: Spalinger
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000209:etiology*; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology*; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000209:etiology*; D020878:Device Removal; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology*; D010535:Laparoscopy; D011782:Quadriplegia / Q000628:therapy*; D014057:Tomography, X-Ray Computed