Percutaneous Cecostomy Research Articles

Percutaneous cecostomy: 25-year two institution experience.

Reports of technical success, adverse events, and long-term outcome of percutaneous cecostomy in children are limited. To characterize technical success, 30-day severe adverse events, and long-term outcome of percutaneous cecostomy at two centers. A retrospective review of hospital course and long-term follow-up (through May 2022) of percutaneous cecostomy tubes placed May 1997 to August 2011 at two children's hospitals was used. Outcomes assessed included technical success (defined as successful tube placement into the colon allowing antegrade colonic enemas), length of stay, 30-day severe adverse events, surgery consults, surgical repair, VP shunt infection, ongoing flushes, tube removal, duration between maintenance tube exchanges, and deaths. A total of 215 procedures were performed in 208 patients (90 institution A, 125 institution B). Tubes were placed for neurogenic bowel (72.1%, n = 155) and functional constipation (27.9%, n = 60). Technical success was 98.1% (211/215) and did not differ between centers (p = 0.74). Surgical repair was required for bowel leakage in 5.1% (11/215) and VP shunt infection was managed in 2.1% (2/95). Compared to functional constipation, patients with neurogenic bowel had higher % tube remaining (65.3% [96/147] versus 25.9% [15/58], p < 0.001) and higher ongoing flushes at follow-up (42.2% [62/147] versus 12.1% [7/58], p < 0.001). Tube removal for dissatisfaction occurred in 15.6% [32/205] and did not differ between groups (p = 0.98). Eight deaths due to co-morbidity occurred after a median of 7.4 years (IQR 9.3) of tube access. Percutaneous cecostomy is technically successful in the vast majority of patients and provided durable access in most. Bowel leakage and VP shunt infection are uncommon, severe adverse events.

S187 Percutaneous Endoscopic Colostomy: A Systematic Review of More Than Two Decades Experience

Introduction: Percutaneous endoscopic colostomy (PEC) is a minimally invasive procedure used to treat recurrent colonic pseudo-obstruction, sigmoid volvulus, chronic intracTable constipation, and neurogenic bowel. Traditional management of these conditions involving surgical colostomy or bowel resection in many cases has been replaced by percutaneous approaches under imaging or endoscopic guidance due to high rates of technical success and low morbidity rates. We conducted a systematic literature review to summarize the use, indications, and complications of PEC in adult patients. Methods: A systematic literature review was conducted using PubMed, Medline, Google Scholar, and Embase to identify patients who had undergone PEC for any indication. The search terms used were “percutaneous endoscopic colostomy”, “percutaneous endoscopic cecostomy”, “percutaneous cecostomy”, and “percutaneous colostomy”. Exclusion criteria were colostomy tubes that were not placed endoscopically. Results: A total of 11 observational studies (3 prospective, 8 retrospective), 18 case reports, and 7 case series between 1998 and 2022 were identified. A total of 318 patients who underwent PEC were identified. The mean age was 66.4 ± 23.5 and 64% were male. The most common indication was sigmoid volvulus (n= 131) followed by pseudo-obstruction (n=43), chronic intrac table constipation (n=83), neurogenic bowel (n=45), and others (n=9). The procedure was technically successful in 311 patients (97.7%). The total complication rate was 37.6%, 83.5% (n=66) of which were minor complications such as pain, bleeding, infection, leakage, and 16.4% (n=13) of which were major complications such as peritonitis, pneumoperitoneum, and sepsis. PEC-related mortality was 1.3% (n=4). The most common locations for tube placement were the left colon (59%) followed by right colon (13%), the rest of the cases the location was not reported. The number of tubes removed was 57, 8 due to symptom resolution, 3 for planned colostomy, and 1 for pain. (Figure) Conclusion: PEC is an underutilized procedure that offers a viable treatment alternative for select patients who are deemed high risk for surgical intervention and in whom conservative therapy is unsuccessful. It can lead to durable relief of symptoms with good technical success and low risk of major complications. Further prospective studies are needed to establish the optimal placement technique, long-term efficacy, and safety.Figure 1.: Percutaneous Endoscopic Colostomy tube indications

Therapeutic utility of percutaneous cecostomy in adults: an updated systematic review.

Objective:Percutaneous cecostomy is a minimally invasive procedure that provides access to the colon for therapeutic interventions. This review aimed to update and summarize the existing information on the use and application of percutaneous endoscopic cecostomy in the field of therapeutic gastroenterology.Data Sources:A systematic review of the literature was performed without any restrictions on the year of publication from the date of inception in 1986 to January 2021.Methods:The review was performed using the medical subject heading keywords in the following search engines: MEDLINE, EMBASE, Cochrane, and Google Scholar.Results:A total of 29 articles were subjected to final data extraction. The review included a total of 174 patients who underwent percutaneous cecostomy. Most of the included studies were conducted in the United States (n = 14). The most common comorbidity was cancer (n = 10) and the major indication for performing percutaneous cecostomy was colonic pseudo-obstruction or Ogilvie’s syndrome (n = 15). The main technique for performing percutaneous cecostomy was endoscopy (17 studies), followed by fluoroscopy- (five studies), computed-tomography- (three studies), laparoscopy- (two studies), and ultrasound- (one study) guided procedures. The procedure was technically successful in 153 (88%) cases. The total cumulative rates of major and minor complications were 47.5%. These complications included tube malfunction, local wound site infections, and bleeding and rare complications of peritonitis and death.Conclusion:Percutaneous cecostomy is a safe and effective option for managing acute colonic pseudo-obstruction. It leads to durable symptom relief with low to minimal risk.

Abstract No. 437 Fluoroscopically guided, percutaneously placed cecostomies versus surgically placed cecostomies in adult patients: a safety comparison

To compare the safety of fluoroscopically guided, percutaneously placed cecostomies versus surgically placed cecostomies in adult patients with colonic dysmotility. A retrospective query of the electronic medical record identified all adult patients who had cecostomies placed at a single, large academic medical center from December 2004 through December 2019. Patients without adequate documentation were excluded. The primary outcomes were cecostomy-related adverse events and technical success. Adverse events were categorized per the Society of Interventional Radiology (SIR) Adverse Event Classification and defined as either early or late based on the dates of cecostomy placement and exchange. Any complications unrelated to the cecostomy placement were excluded. Univariate and multivariate analysis was used to assess the association between procedural type and postprocedural complications. 67 adults patients underwent cecostomy placement for refractory colonic dysmotility with 50/67 (74.6%) placed percutaneously. The most common indication for cecostomy was neurogenic bowel associated with spina bifida (18/67; 27%). Four (5.9%) patients received venting cecostomy in the setting of colonic pseudo-obstruction. The median LOS for patients who had surgically placed cecostomies (SPC) was 6 days (IQR 5,10 days) while the median length of stay for patients who had fluoroscopically guided, percutaneously placed cecostomies (PPC) was 2 days (IQR 1,4 days) (P = 0.0003). Five SPC patients and 21 PPC patients and had early complications. SPC patients were 22.4 times more likely to experience a late complication than those in the PPC group. There was no difference in the severity of the complications between the two groups. Fluoroscopy-guided, percutaneous cecostomy placement is a minimally invasive alternative to surgery with shorter LOS, fewer complication rates, and similar complication severity.

Colonoscopy-Assisted Creation of Antegrade Continent Enema Tract in a Patient With Spina Bifida

Spina bifida is a neural tube defect that affects 33-52/100,000 live births. Bowel incontinence affects 60-70% of all patients, and is a source of significant limitation to social interactions. When first line treatment with traditional laxatives fail, an antegrade continence enema (ACE) tract can help improve quality of life. An 18-year-old woman with spina bifida and hydrocephalus was referred for neurogenic bowel characterized by severe constipation and daily fecal incontinence. She had tried several bowel regimens with inconsistent benefit. Her surgical history was complicated by hydrocephalus requiring 2 ventriculoperitoneal shunts, bladder rupture, and bladder augmentation. After discussion of possible options, she elected to undergo an ACE procedure and was referred to pediatric surgery. A plan was made to try a laparoscopic approach, with colonoscopy rescue procedure planned is this was unsuccessful. On the day of procedure, multiple attempts to gain laparoscopic access through the suprapubic and epigastric routes were unsuccessful due to thick adhesions from past surgeries. Both wounds were closed, and gastroenterology was called to proceed with a colonoscopy-assisted procedure. Colonoscopy was accomplished without difficulty with a cecal intubation time of 7 minutes. Attempts at transillumination in the cecum failed. A spot with good transillumination and good one-to-one colonic indentation was identified in mid-ascending colon. Three T-fasteners were deployed in a triangular fashion under endoscopic visualization to anchor the ascending colon to the abdominal wall. A small cruciate incision was made and a needle was passed into the ascending colon. A guidewire was placed through the needle, and the tract dilated to 11 F. A 10.2 F Chait percutaneous cecostomy catheter was deployed using an introducer over the guidewire and placed under visualization in the ascending colon, creating a tract through which antegrade enema could be administered. Procedure time from scope insertion to withdrawal was 27 minutes. The patient was discharged home the day after the procedure. On telephone follow up, she reported excellent bowel control since the procedure was completed. Our report indicates that colonoscopy-assisted creation of an ACE tract can be accomplished without difficulty when laparoscopy may be difficult due to adhesions, or where the appendix may not accessible for a traditional Mallone ACE procedure.Figure: Chait percutaneous cecostomy tube in colon.

Percutaneous Cecostomy in Adult Patients: Safety and Quality-of-Life Results

PurposeTo assess the safety and quality of life in adult patients undergoing cecostomy tube placement. Materials and MethodsPercutaneous cecostomy was performed in 23 adults (10 men and 13 women) with neurogenic bowel for whom noninvasive therapeutic approaches for chronic refractory constipation or fecal incontinence had failed. Mean patient age was 41 years (range, 19–74 y). A retrospective, standardized questionnaire evaluated satisfaction and quality of life before and after cecostomy. ResultsAll 23 cecostomy procedures were technically successful with no intraprocedural complications. At a mean follow-up of 42 months (range, 1–160 mo), there was one (5%) major complication, a pericecal abscess. One or more minor complications in 11 of 23 (48%) patients included leaking around the tube (5 of 23; 22%) and partial or complete dislodgment of the tube (3 of 23; 13%). In all cases, the cecostomy tube was exchanged successfully. Satisfaction scores improved from a mean of 2.2 points (range, 0–6 points; median, 1.5) to 7.6 points (range, 4–10 points; median, 8). The percentage of patients using laxative softeners decreased from 74% to 40%, and patients requiring assistance decreased from 52% to 35% after cecostomy placement. ConclusionsPercutaneous cecostomy is a safe procedure for the management of adult patients. Patients are able to achieve greater independence in their activities of daily living and are highly satisfied with the outcomes.

Ogilvie's syndrome–acute colonic pseudo-obstruction

Ogilvie's syndrome describes an acute colonic pseudo-obstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. It often occurs in debilitated patients. Its pathophysiology is still poorly understood. Since computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, the possibility of organic colonic obstruction must be excluded. If there are no criteria of gravity, initial treatment should be conservative or pharmacologic using neostigmine; decompression of colonic gas is also a favored treatment in the decision tree, especially when cecal dilatation reaches dimensions that are considered at high risk for perforation. Recurrence is prevented by the use of a multiperforated Faucher rectal tube and oral or colonic administration of polyethylene glycol (PEG) laxative. Alternative therapeutic methods include: epidural anesthesia, needle decompression guided either radiologically or colonoscopically, or percutaneous cecostomy. Surgery should be considered only as a final option if medical treatments fail or if colonic perforation is suspected; surgery may consist of cecostomy or manually-guided transanal pan-colorectal tube decompression at open laparotomy. Surgery is associated with high rates of morbidity and mortality.

The Percutaneous Cecostomy Tube in the Management of Fecal Incontinence in Children

PurposeTo retrospectively evaluate experience with percutaneous cecostomies and their long-term outcomes. Materials and MethodsBetween June 1994 and March 2009, 290 patients (mean age, 10.1 y) with fecal incontinence underwent percutaneous cecostomy tube placement and subsequent tube management. Technical success, procedural complications, and long-term follow-up until March 2012 were evaluated. ResultsA cecostomy was successfully placed in 284 patients (98%), and 257 of 280 patients (92%) underwent a successful exchange to a low-profile tube. A total of 1,431 routine exchanges to low-profile tubes were reviewed in 258 patients (mean, 1.6 ± 1.3 routine tube changes per 1,000 days). Eighty-five patients (29%) experienced one or more early problems after cecostomy, and 10 (3%) had major complications. In the total 463,507 tube-days, 938 late problems were noted: 917 (98%) minor and 22 (2%) major. Forty patients had the cecostomy catheter removed and 141 “graduated” to an adult health care facility. ConclusionsThe percutaneous cecostomy procedure provides a safe management option for fecal incontinence in the pediatric population.

3:48 PM; Abstract No. 73 - Percutaneous cecostomy in adult patients: indications, efficacy, and quality of life results

3:48 PM; Abstract No. 73 - Percutaneous cecostomy in adult patients: indications, efficacy, and quality of life results

3:39 PM, Abstract No. 72 - Safety and efficacy of percutaneous cecostomy for treatment of large bowel obstruction in adult cancer patients

Safety and efficacy of percutaneous cecostomy for treatment of large bowel obstruction in adult cancer patients S.O. Tewari, G. Getrajdman, A.M. Covey, E.N. Petre, M.R. Weiser, R.H. Thornton, L.A. Brody, C.T. Sofocleous, M. Maybody, W. Alago, Jr., A. Aguado, R.H. Siegelbaum, J.C. Durack, J.P. Erinjeri, H. Yarmohammadi, K.T. Brown, S.B. Solomon; Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Surgery, Memorial SloanKettering Cancer Center, New York, NY

Laparoscopic-Assisted Percutaneous Cecostomy for Antegrade Continence Enema

The antegrade continence enema (ACE) is an option in the management of fecal incontinence and chronic constipation. We report our experience with a simple laparoscopic technique. Data were collected on 16 children (8 boys) who underwent laparoscopic cecostomy for ACE. Success was defined as cessation of fecal soiling with no need for diapers. Mean age at laparoscopic cecostomy was 11 years (range, 6-16 years). Mean follow-up after initial cecostomy was 22 months (range, 6-51 months). Diagnoses in 16 patients were functional constipation with soiling (n=14), incontinence after surgery for Hirschsprung's disease (n=1), and constipation secondary to mitochondrial disease (n=1). Seven had significant developmental or psychiatric problems. Three patients had primary placement of a trapdoor device (Chait); 13 had placement of a long tube, with later replacement by a skin-level device. We have evolved a laparoscopic-assisted percutaneous technique, using metallic anchor sutures on the cecum, and a dilator and peel-away sheath for introduction of the catheter. Complications occurred in 5 patients; 3 returned to the operating room: 1 for tube occlusion, 1 for suture granuloma, and 1 for a dislodged tube at 7 months postoperatively. One patient received intravenous antibiotics because of suspected peritonitis on the first postoperative day. One was re-admitted with abdominal pain. Five of 16 patients have failed therapy (four tubes removed and one tube in situ). Three have had only minor improvement. Eight have had successful ACE management, of whom 1 patient has had his tube removed after resolution of symptoms. Of 8 patients with no or minimal improvement with ACE, 5 have significant psychiatric problems. Laparoscopic-assisted percutaneous cecostomy has an excellent safety profile and patient comfort. The procedure is simple, secure, and reversible. Results were excellent in half of the patients. Associated psychiatric or behavioral problems may predict poor response to ACE.

Outcomes Following Fecal Continence Procedures in Patients with Neurogenic Bowel Dysfunction

Malone antegrade continence enema and cecostomy button improve quality of life in patients with neurogenic bowel. However, they have not been compared regarding fecal continence outcomes. We compared these 2 procedures with respect to continence, complications and conversions. We retrospectively reviewed the charts of patients who underwent Malone antegrade continence enema or cecostomy at the University of Alberta between January 2006 and January 2011. A total of 26 patients underwent Malone antegrade continence enema, of whom 20 underwent concomitant Monti procedure and bladder augmentation, 5 a laparoscopically assisted procedure and 1 concomitant ileovesicostomy. A total of 23 patients underwent cecostomy, of whom 1 underwent ileovesicostomy, 1 bladder augmentation, 1 a Monti procedure with bladder augmentation and 1 laparoscopic cecostomy. Continence was defined as ability to wear underwear with no accidents at most recent annual followup, which was a minimum of 1 year postoperatively. Fecal continence rates were 84.6% for Malone antegrade continence enema and 91.3% for cecostomy. There were no statistically significant differences in continence based on procedure (p = 0.48), age (p = 0.97) or gender (p = 0.54). Of patients who underwent cecostomy 8.7% switched to the Malone antegrade continence enema, while 11.5% with Malone antegrade continence enema switched to cecostomy. Mean length of hospital stay for patients undergoing cecostomy vs laparoscopically assisted Malone antegrade continence enema was 4.0 vs 5.2 days (p = 0.15). Complications included stomal pain (23.1% of patients) and difficulty with catheterizing (19.2%) following Malone antegrade continence enema, and difficulty flushing (26.1%) following cecostomy. There were no significant differences between Malone antegrade continence enema and cecostomy button with respect to fecal continence or complication rates. Each approach poses unique challenges, suggesting that patients and families need to understand the differences to make an individualized choice.

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

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.

Transcecostomal colonic stent placement after US-guided percutaneous cecostomy

Colorectal stenting for the treatment of malignant largebowel obstruction is useful for palliation or as a bridge to surgery. 1 It is more difficult to position a stent in the rightsided colon by using a retrograde placement method via the rectum compared with the distal colon. Herein, we present a case involving the successful antegrade placement of a stent in the ascending colon after US-guided percutaneous cecostomy.

Percutaneous cecostomy in the management of organic fecal incontinence in children

To assess the effectiveness and safety of imaging-guided percutaneous cecostomy in the management of pediatric patients with organic fecal incontinence. Twenty three cecostomies were performed on 21 children with organic fecal incontinence (13 males, 8 females), aged from 5 to 16 years (mean 9.5 years). Thirteen patients had neurogenic fecal incontinence and 8 patients had anorectal anomalies. Procedures were performed under general anesthesia and fluoroscopic guidance. Effectiveness and complication data were obtained for at least 1 year after the procedure. Cecostomy was successful in 20 patients (primary technical success rate 95%). Cecostomy failed in one patient due to tube breakage (secondary technical success rate 100%). The tubes were in situ for an average of 18 mo (range 12-23 mo). Eighteen patients (87%) expressed satisfaction with the procedures. Resolution of soiling was achieved in all patients with neurogenic fecal incontinence (100%) and in 5 of 8 patients with anorectal anomalies (62.5%). Eleven patients (52%) experienced minor problems. No major complications were noted. Percutaneous cecostomy improves the quality of life in children with organic fecal incontinence. A satisfactory outcome is more prevalent in patients with neurogenic fecal incontinence than anorectal anomalies.

Cecostomy button for antegrade enemas: survey of 29 patients

Objective This study evaluated the Trap-door button use (Cook Medical, Bloomington, IL) for antegrade enemas in children. Methods Since 2002, patients with fecal incontinence or encopresis and constipation underwent percutaneous cecostomy under laparoscopy using a button. Technical details are described. Age at surgery, operative time, hospital stay, diagnosis, indications for cecostomy, and duration of follow-up were recorded. A survey was proposed via a questionnaire that was sent to the patients. Patients wearing the button for less than 1 month were excluded from this evaluation. The survey concerned volume and frequency of enemas, difficulties encountered, benefits and disadvantages of this method, and assessment of the antegrade enemas in continence. Results Twenty-nine patients, 18 males and 11 females, aged 3 to 21 years (mean, 8.5 years) underwent laparoscopic Trap-door button placement. The indications for all the patients were intractable fecal incontinence in 24 cases and constipation with encopresis in 5 cases. Incontinence was because of myelomeningocele (n = 10), anorectal malformations (n = 11), caudal regression syndrome (n = 1), 22q11 syndrome (n= 1), and Hirschsprung disease with encephalopathy with convulsions (n = 1). Constipation with encopresis was because of sacrococcygeal teratoma (n = 1), cerebral palsy (n = 1), and acquired megarectum with psychiatric and social disorders (n = 3). A total of 26 cecostomy button placements and 3 sigmoidostomy button placements were successful with no intraoperative complication. The mean operative time was 25 minutes (10-40 minutes), and the hospital stay was 2.5 days (1-4 days). Twenty-two parents or patients answered the questionnaire. At the time of this survey, 2 patients had improved their fecal continence and had had the button removed. A mean of 4 weekly enemas was enough to improve fecal continence troubles (range, 1 daily to 1 for 2 weeks). The volume for enemas was 250 to 1000 mL (mean, 700 mL). The time required for the irrigation of the bowel by gravity took from 5 to 60 minutes (mean, 25 minutes) for 20 patients. Before surgery, 14 patients needed a diaper, day and night, and 6 needed sanitary protection. Soiling was a very significant inconvenience for all the patients. After surgery, only 5 patients needed a diaper (cerebral palsy, 22q11, cloacal malformation, myelomeningocele, bladder exstrophy) because of moderate results or urinary incontinence and continued soiling. Patients were asked to give an assessment (null = 0, bad = 1, fair = 2, good = 3, very good = 4). None of the patients felt there had been no changes or a bad result. There were 5 patients who felt they had an average result, 5 a good result, and 12 a very good result. The mean grade was 3.44 (17.2/20). A total of 3 patients had hypertrophic granulation tissue formation around the cecostomy button, and 12 had tiny leakage. Conclusion Percutaneous placement of a cecostomy button under laparoscopic control is an easy and major complication-free procedure. The use of the Trap-door device by the patients or with the help of the parents for antegrade enemas is effective and satisfactory. It improves the quality of life and is reversible.

Novel method for recolonoscopy after percutaneous cecostomy

Novel method for recolonoscopy after percutaneous cecostomy

Percutaneous Cecostomy for Management of Fecal Incontinence in Pediatric Patients

To report the authors' experience with percutaneous cecostomy and demonstrate its effectiveness in the management of pediatric patients with fecal incontinence. Between March 2002 and November 2006, 21 percutaneous cecostomy procedures were performed in 20 patients in whom classical therapeutic approaches for the management of fecal incontinence had failed. Eighteen patients had anorectal malformations, one had myelomeningocele, and one had chronic constipation. All procedures were performed under general anesthesia and fluoroscopic guidance. In all cases, an 8.5-F Dawson-Mueller catheter was placed in the cecum and exchanged after 45 days with a cecostomy button (ie, Trapdoor catheter). Data regarding complications, effectiveness of treatment, satisfaction, and quality of life were obtained by interviewing the patients' parents at follow-up consultation. Nineteen of 20 procedures were technically successful. There were no major complications. All patients' symptoms of incontinence improved. Ninety percent of patients in our series (n = 18) reported satisfaction with the procedure, mainly related to their independence and quality of life. Percutaneous cecostomy is a safe and effective procedure for the management of pediatric patients with fecal incontinence. Percutaneous cecostomy allows antegrade and more physiologic colon irrigation, avoiding the need for multiple retrograde enemas, achieving more patient independence, and improving quality of life.

Novel Method for Re-Colonoscopy After Percutaneous Cecostomy

Novel Method for Re-Colonoscopy After Percutaneous Cecostomy

Percutaneous endoscopic cecostomy in adults: a case series

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. Report our experience with percutaneous endoscopic cecostomy in adults. Case series. Single tertiary referral center in the United States. Five patients with recurrent colonic pseudoobstruction and 2 with chronic refractory constipation. Percutaneous endoscopic cecostomy. 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. Retrospective, single-center study. 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.