Patient: I have a peg tube that goes into my intestines. I had a lump to come by beside it. The dr cut the lump and let it drain. This was 2 months ago. I have fecal matter coming out of the lump and also around the tube. Is this normal?
Doctor: Hello,Thank you for your medical query at AskTheDoctor.comI understand your concern.From your description, you h ave a PEG tube going to the intestine for giving you enteral nutrition. However, it is not clear to me the reason for which PEG tube was put. That is one of the important factors to determine the healing/closure of the fistula – the condition which you are suffering from.In the course of time you developed obstruction distal to the PEG insertion site and that’s why your surgeon opened the lump and tried to create a controlled fistula with the aim that it will close spontaneously or the tract has to be excised at a later date if it doesn’t close spontaneously.Now you have 2 entero-cutaneous faecal fistulas one created by your surgeon to relieve obstruction and the other has formed in the course of time from the opening for PEG tube insertion. Definitely this condition is not normal and requires attention that’s where your diagnosis and the reason for PEG tube insertion could have helped me to give you proper advice.Kindly consult your treating surgeon and get a CT abdomen and CT fistulogram to see the extent of the fistula tract from the skin to bowel. How much is the output of faecal matter? If i is more than 500mg/dl it is a high output fistula and will not heal spontaneously and the tract has to be excised. As you have two fistulas, I feel for you surgical excision of the fistulous tract will be ideal.Kindly consult your surgeon or surgical gastroenterologist and follow his advice.if the faecal output is more than 500mg/dl enteral nutrition has to be stopped and TPN to be started followed by fistula closure.Hope this was helpful,Regards