Endoscopic-assisted Colopexy and Push Percutaneous Colostomy in the Transverse Colon for Refractory Chronic Intestinal pseudo-Obstruction

• DOI: 10.1097/sle.0b013e3182319a9e
• Publication Date: 2011-12-06T09:27:44Z
• Authors: Javier Molina-Inf...; Jose M. Mateos-Ro...; Gema Vinagre-Rodr...; Elisa Martin-Nogu...; Jesus M. Gonzalez...
• Keywords: Male; 03 medical and health sciences; Fatal Outcome; 0302 clinical medicine; Chronic Disease; Colonic Pseudo-Obstruction; Colostomy; Humans; Colonoscopy; Aged; Colon, Transverse

Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy.