GASTROJEJUNAL FISTULA FOLLOWING GASTROSTOMY TUBE

Objectives: Gastrostomy tubes are often placed in patients with poor voluntary intake, oropharyngeal dysphagia, or chronic illness to provide definitive nutritional access. Despite the widespread use of gastrostomy tubes, some patients can experience complications associated with this procedure including gastrocoliccutaneous fistula and dislodgement of gastrostomy tube. The case discussed an instance of gastrojejnual fistula following gastrostomy tube placement.

Methods: Thorough review of a complication from gastrostomy tube placement.

Results: 71-year-old female with a history of congestive heart failure, type II diabetes, hypertension, multiple CVAs with residual cognitive deficits, and gastrostomy tube dependence presented from a nursing home in August 2022 with reports of abdominal pain, fever, and emesis. The outside hospital obtained a CT revealing a gastrostomy tube traversing the posterior wall of the stomach and creating a fistula into the jejunum, with the balloon inflated within jejunum.
The patient had previously undergone placement of a percutaneous gastrostomy tube in April 2021. When inserted, the tube was noted to be 4cm at the skin. Per nursing home records, the gastrostomy had last been exchanged by nursing home staff 3 weeks previously with the balloon inflated to 20cc. The gastrostomy tube now noted to be 12cm at the skin.
The patient was noted to be vitally stable and nontender on exam, therefore a gastrostomy tube study was performed under fluoro which revealed contrast promptly entering the jejunum without extraluminal extravasation. The patient was able to drink a small amount of contrast followed by xray imaging proving the contrast was within the gastric lumen with no extravasation.
The next morning the gastrostomy tube was removed and a new one was placed at 4cm. CT with gastrostomy tube study was performed and revealed no extravasation of contrast with contrast noted within the large bowel and the appendix. The patient was discharged home and is doing well at the nursing home.

Conclusion: This case shows an instance of gastrojejunal fistula formation following gastrostomy tube placement over a year after percutaneous placement. This formation was likely helped by the depth of the gastrostomy tube when replaced by nursing home, and further encourages careful monitoring following initial placement.