title: Safety and efficacy of percutaneous cecostomy/colostomy for treatment of large bowel obstruction in adults with cancer.
abstract: OBJECTIVE
  To assess the safety and efficacy of image-guided percutaneous cecostomy/colostomy (PC) in the management of colonic obstruction in patients with cancer.
  
  
  METHODS
  Twenty-seven consecutive patients underwent image-guided PC to relieve large bowel obstruction at a single institution between 2000 and 2012. Colonic obstruction was the common indication. Patient demographics, diagnosis, procedural details, and outcomes including maximum colonic distension (MCD; ie, greatest transverse measurement of the colon on radiograph or scout computed tomography image) were recorded and retrospectively analyzed.
  
  
  RESULTS
  Following PC, no patient experienced colonic perforation; pain was relieved in 24 of 27 patients (89%). Catheters with tip position in luminal gas rather than mixed stool/gas or stool were associated with greater decrease in MCD (-40%, -12%, and -16%, respectively), with the difference reaching statistical significance (P = .002 and P = .013, respectively). Catheter size was not associated with change in MCD (P = .978). Catheters were successfully removed from six of nine patients (67%) with functional obstructions and two of 18 patients (11%) with mechanical obstructions. One patient underwent endoscopic stent placement after catheter removal. Three patients required diverting colostomy after PC, and their catheters were removed at the time of surgery. One major complication (3.7%; subcutaneous emphysema, pneumomediastinum, and sepsis) occurred 8 days after PC and was successfully treated with cecostomy exchange, soft-tissue drainage, and intravenous antibiotic therapy.
  
  
  CONCLUSIONS
  Image-guided PC is safe and effective for management of functional and mechanical bowel obstruction in patients with cancer. For optimal efficacy, catheters should terminate within luminal gas.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Sanjit O
authors.initials: SO
authors.lastname: Tewari
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: George I
authors.initials: GI
authors.lastname: Getrajdman
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: petree@mskcc.org.
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Siegelbaum
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Thornton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome