Spontaneously closed gastrocutaneous fistula becomes symptomatic after 30 years with pregnancy

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Obstetrics

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common procedure for long-term enteral nutrition in children.
• Gastrocutaneous fistulas are a known complication of PEG tube removal, typically managed in childhood.
• This case explores a delayed presentation of a gastrocutaneous fistula in adulthood.

Observation:

• A 34-year-old woman, who underwent PEG at age four for caustic esophageal injury, presented with a recurrent fistula during pregnancy.
• The fistula became more apparent as the pregnancy progressed, necessitating hospital admission at 34 weeks gestation.
• The patient successfully delivered her child before the fistula was surgically addressed.

Findings:

• The study documents a unique case of a gastrocutaneous fistula recurring three decades after the initial PEG procedure.
• Pregnancy was identified as a potential exacerbating factor for the late-onset fistula.
• Surgical repair of the fistula was performed successfully post-delivery.

Implications:

• This case underscores the potential for long-term complications from childhood PEG procedures, even after decades.
• It highlights the importance of recognizing and managing gastrocutaneous fistulas in adults, particularly during pregnancy.
• Further research may be warranted to understand the factors contributing to late-onset fistula recurrence.