Percutaneous endoscopic gastrostomy through the sinus tract of a surgical gastrostomy

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.