# Malposition of Percutaneous Endoscopic Gastrostomy (PEG) Tube Through the Transverse Colon: A Novel Approach to Conservative Management

## TL;DR

A novel conservative surgical approach successfully managed a rare complication of a mispositioned PEG tube in a cancer patient.

## Contribution

A new conservative surgical method for managing gastrocolocutaneous fistulas caused by PEG tube malposition.

## Key findings

- A laparoscopic-assisted PEG tube insertion successfully replaced the malpositioned tube.
- The original fistulous tract sealed and fell out within a week, allowing enteral feeding through the new site.
- The proposed approach avoids invasive surgery and offers a better clinical outcome for high-risk patients.

## Abstract

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.