Non-operative management of a rare late gastrocolic fistula after percutaneous endoscopic gastrostomy in pediatrics

Gastrocolic fistula is a rare but serious complication of percutaneous endoscopic gastrostomy (PEG). A 13-year-old male with quadriplegic cerebral palsy and a PEG inserted two years prior presented with a one-month history of watery, foul-smelling diarrhea, weight loss, and bilateral lower-limb edema. Laboratory tests revealed anemia and hypoalbuminemia (1.9 g/dL) , with otherwise unremarkable sepsis workup. Despite nutritional support and albumin infusions, his condition deteriorated. A contrast study performed via the PEG demonstrated opacification of the colon, confirming a gastrocolic fistula with the gastrostomy tube positioned within the transverse colon . The PEG was removed, and the patient was managed conservatively with total parenteral nutrition for ten days. A repeat contrast study confirmed complete fistula closure , after which nasogastric feeding was resumed. Three weeks later, a new gastrostomy was safely reinserted under laparoscopic guidance, with sustained clinical recovery. Gastrocolic fistula must be suspected in patients that have a percutaneous endoscopic gastrostomy and develop new-onset diarrhea and malnutrition. Conservative management may lead to spontaneous closure of the fistula.