Transcolonic misplacement as a rare complication associated with PEG tube

Abstract

An 84-year male patient with a past medical history of coronary artery disease, heart failure with preserved ejection fraction, hypertension, and chronic dysphagia status post percutaneous gastrostomy tube (PEG) placement presented for worsening hemoglobin levels on laboratories. The patient was asymptomatic on admission.The patient denied any melena, hematochezia, diarrhea, constipation, vomiting, hematemesis, and abdominal pain. His hemoglobin was 7 (reference range 13.8-17.2) g/dL on admission; therefore, he received 1 unit of packed red blood cells. The patient was scheduled for colonoscopy because of suspicion of iron deficiency anemia secondary to chronic blood loss. The total procedure time of colonoscopy was 92 min due to dense diverticular disease in the left colon, extremely difficult cecal intubation, and a large polyp in a difficult/unstable position, requiring scope exchange for completion of polypectomy. PEG tube shaft was noted going through the transverse colon (Figure 1). The PEG tube was placed 6 months prior to colonoscopy. Gastrocolic fistula was diagnosed clinically and confirmed on the CT scan of the abdomen. The definitive treatment for misplaced PEG tube includes surgical removal or endoscopic removal of PEG tube; however, the patient refused any further interventions. | DISCUSSION AND CONCLUSIONPEG is a favorable route of feeding and nutritional support in patients with a functional gastrointestinal system who require long term enteral nutrition, generally beyond 4 weeks. Feeding tubes designed for long term include gastrostomy

Jejunal lipoma complicated with small bowel bleeding

“…Small bowel lipomas are generally asymptomatic benign tumors, although when their size is>2 cm they can cause complications, mainly intussusception and gastrointestinal bleeding due to ulceration/necrosis, complications usually associated with malignant tumors. 1 2 3…”