Abstract. An 82-year-old woman underwent percutaneous endoscopic gastrostomy (PEG) 5 years after partial gastrectomy for cancer. Four months after PEG insertion, a colocutaneous fistula was noted at exchange of the PEG tube. Colocutaneous fistula is a rare and major complication of PEG with 10 reported cases to date. In eight of the 11 reported cases, including this case, fistulas appeared late (6 weeks) after PEG insertion. This complication may heal after removal of the PEG alone, if the fistula has formed completely; otherwise a surgical approach is necessary for the treatment. Since five of the 11 reported patients had previously undergone abdominal surgery, prior abdominal surgery may increase the risk of a colonic injury after PEG. Open surgical gastrostomy is a wiser option when performing gastrostomy in patients with prior abdominal surgery.