How do colocutaneous fistulas occur with PEG placement, and what is their prevalence?

• A. When the colon is inadvertently punctured during placement; 0-0.27%
• B. From prolonged tube use; 5-10%
• C. From improper tube cleaning; 2-3%
• D. From allergic reaction; 0%

Answer: (B)

Colocutaneous fistulas after PEG are a late complication caused by the tube remaining in place for an extended period. Over time, continuous pressure, irritation, and tube movement can lead to ischemia and erosion of the PEG tract, and if the colon lies adjacent to or is interposed in the tract, a fistulous connection between the colon and the skin can form. This explains why prolonged tube use is linked to the development of a colocutaneous fistula, and the prevalence is typically cited around 5-10%. Immediate misplacement or puncture during insertion would present differently (acute issues), while poor cleaning or an allergic reaction does not create a fistula between colon and skin.