title: Percutaneous endoscopic colostomy of the left colon: a new technique for management of intractable constipation in children.
abstract: BACKGROUND
  The antegrade colonic enema is accepted as effective for management of intractable constipation in children when conventional bowel management has failed. This study describes experience with a new, minimally invasive technique, the distal antegrade colonic enema, which involves percutaneous endoscopic colostomy of the left colon.
  
  
  METHODS
  Fifteen children with refractory constipation and soiling who had radiographic evidence of megarectum and/or distal colonic delay were selected for the procedure. The junction of the descending and the sigmoid colon was identified colonoscopically, and the percutaneous endoscopic colostomy tube, through which antegrade distal colonic enema are administered, was inserted.
  
  
  RESULTS
  Fourteen children underwent distal percutaneous endoscopic colostomy insertion. The median time required for the procedure was 30 minutes (20-50 minutes). Excluding one child (technical difficulties with percutaneous endoscopic colostomy placement), median post-procedural hospital stay was 4 days (2-27 days). Thirteen children were no longer soiling, and improvement in quality of life was reported at 2 months' follow-up. At 6 months' follow-up, 90% of children were clean during intervals between enemas. All children evaluated at 12 months' follow-up remained clean. Median duration of follow-up was 12.5 months (2-51 months).
  
  
  CONCLUSIONS
  The distal percutaneous endoscopic colostomy is a simple alternative to established methods for delivery of antegrade enemas. It is less invasive and on reversal leaves only minor scarring.
authors.affiliation: Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Rawat
authors.forename: Munther
authors.initials: M
authors.lastname: Haddad
authors.forename: Niamh
authors.initials: N
authors.lastname: Geoghegan
authors.forename: Simon
authors.initials: S
authors.lastname: Clarke
authors.forename: John M
authors.initials: JM
authors.lastname: Fell
mesh_terms: D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D003125:Colostomy / Q000379:methods*; D003248:Constipation / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male