Percutaneous Endoscopic Cecostomy (PEC) Tube Placement: A Case Series

Abstract

Purpose: Percutaneous cecostomy (PEC) placement has been used to treat recurrent colonic pseudobstruction, colonic atony or obstipation in children since it was first described in the 1980s. However, its role in the adult patient population for similar indications or palliation has yet to be defined. There have only been a few published case reports of successful PEC placement in adults. We report our experience with PEC placement in two adult patients at our institution with colonic atony and dilated colons (Figure A). Methods: With the patient in the supine position, a site was identified in the ascending colon with external transillumination and corresponding indentation on endoscopy in the right lower quandrant. The abdominal wall was marked and prepped in a sterile manner. After a local anesthetic (1% lidocaine) was injected a 22 Gauge needle was advanced under endoscopic visualization into the colon lumen followed by advancement of the trocar needle directly adjacent to the 22 Gauge needle. A snare was introduced through the endoscope and opened in the colonic lumen. The guide wire was passed through the trocar and into the open snare (Figure B). The snare was closed around the guide wire. The endoscope and snare were removed, pulling the wire out through the anus. A skin incision was made at the site of needle insertion. The externally removable Kimberly Clark 20 Fr gastrostomy tube was lubricated and tied to the guide wire and subsequently pulled through the anus and into the colon. The trocar needle was removed, and the colostomy tube was pulled out from the colon through the skin. The external bumper was attached to the colostomy tube, and the tube was cut to remove the guide wire. The final position of the cecostomy tube was confirmed endoscopically (Figure C) and subsequently with an abdominal X-ray (Figure D). The tube was capped and sutured into place externally with 2 vicryl 2.0 sutures, and the tube site was cleaned and dressed. Results: In the cases described above, a colonoscopy was performed without difficulty and successful PEC placement was achieved using the modified PEG pull technique with relative ease. Our patients did well post procedure with complete resolution of their symptoms and were discharged with no active issues secondary to PEC placement. This illustrates how PEC tube placement can be used to safely manage adult patients with colonic atony in day to day practice. Conclusion: PEC is a potentially attractive alternative to surgical or fluoroscopic cecostomy placement. Further study in a prospective fashion needs to be performed to further outline its clinical indications, therapeutic possibilities, and potential complications.