title: Endoscopic-assisted colopexy and push percutaneous colostomy in the transverse colon for refractory chronic intestinal pseudo-obstruction.
abstract: 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.
authors.affiliation: Unit of Gastroenterology, Hospital San Pedro de Alcántara, Caceres, Spain. xavi_molina@hotmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.forename: Jose M
authors.initials: JM
authors.lastname: Mateos-Rodriguez
authors.forename: Gema
authors.initials: G
authors.lastname: Vinagre-Rodriguez
authors.forename: Elisa
authors.initials: E
authors.lastname: Martin-Noguerol
authors.forename: Jesus M Gonzalez
authors.initials: JM
authors.lastname: Santiago
mesh_terms: D000368:Aged; D002908:Chronic Disease; D044684:Colon, Transverse / Q000601:surgery*; D003112:Colonic Pseudo-Obstruction / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D003125:Colostomy / Q000379:methods*; D017809:Fatal Outcome; D006801:Humans; D008297:Male