Case Study
Percutaneous endoscopic cecostomy in adults: a case series

https://doi.org/10.1016/j.gie.2006.02.037Get rights and content

Background

Percutaneous cecostomy is used to treat recurrent colonic pseudoobstruction or obstipation in children and adults with multiple medical comorbidities. Percutaneous endoscopic cecostomy is a potentially attractive alternative to surgical or fluoroscopic cecostomy placement. A few reports describe percutaneous endoscopic cecostomy for management of these problems in children, whereas there are no large series of percutaneous endoscopic cecostomy in adult patients describing the indications, complications, and outcomes.

Objective

Report our experience with percutaneous endoscopic cecostomy in adults.

Design

Case series.

Setting

Single tertiary referral center in the United States.

Patients

Five patients with recurrent colonic pseudoobstruction and 2 with chronic refractory constipation.

Interventions

Percutaneous endoscopic cecostomy.

Results

Eight cases of percutaneous endoscopic cecostomy were performed from May 2001 through October 2005: 6 for colonic pseudoobstruction and 2 for chronic constipation. Seven of 8 cases were successful and resulted in clinical improvement. One patient required surgical removal of the percutaneous endoscopic cecostomy tube at 4 days for fecal spillage resulting in peritonitis despite successful tube placement for chronic constipation. Removal of the cecostomy tube occurred in 3 of 6 cases of pseudoobstruction (the other 3 remain in place). In the other patient with chronic constipation, clinical improvement occurred, but the patient died of underlying illness 21 days after placement. No other serious complications occurred.

Limitations

Retrospective, single-center study.

Conclusions

Percutaneous endoscopic cecostomy is a viable alternative to surgically or fluoroscopically placed cecostomy in a select group of patients with recurrent colonic pseudoobstruction or chronic intractable constipation.

Section snippets

Patients and methods

Seven patients underwent 8 PEC placements between May 2001 and October 2005: 5 patients for recurrent colonic pseudoobstruction and 2 with chronic refractory constipation. One patient with recurrent pseudoobstruction underwent PEC placement twice. The PEC procedure was similar to that described for the PEG pull technique14 as modified by Ponsky et al.7 For patients with refractory constipation, a 2-day preparation of the colon was performed. On day 1, the patients ingested only clear liquids.

Observations

PEC placement was successful in 8 of 8 attempts (6 men, 2 women) (Table 1). One patient with recurrent pseudoobstruction underwent PEC placement twice, the second was placed for symptom recurrence 17 months after having the first one removed for stable clinical improvement.

Procedure duration averaged 71 minutes (range, 37-120 minutes; median, 70 minutes). Two cases were performed on an outpatient basis. Five patients were discharged 2 days after PEC placement, and 1 inpatient remained in the

Discussion

To our knowledge, our retrospective case series represents the largest series to date describing experience with PEC in adults with colonic pseudoobstruction or chronic constipation. Ponsky et al7 first described its use in 1986 in 2 patients with ACPO who were unsuccessfully treated with colonoscopic decompression. In both cases, PEC successfully and rapidly led to colonic decompression without complications. Salm et al8 reported 2 cases of uncomplicated PEC used for venting in adult patients

References (18)

There are more references available in the full text version of this article.

Cited by (55)

View all citing articles on Scopus

Reprint requests: Reprints are not available from the authors.

See CME section; p. 243.

View full text