Constipation Research Today is a free monthly online journal that collates and summarizes the latest research about Constipation, including details on infant, child, baby and toddler constipation, symptoms, causes, remedies. | ||||||||
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Percutaneous endoscopic colostomy of the left side of the colon.Cowlam S, Watson C, Elltringham M, Bain I, Barrett P, Green S, Yiannakou Y Department of Medicine, University Hospital of North Durham, North Road, Durham, UK. BACKGROUND: Percutaneous endoscopic colostomy (PEC) on the left side of the colon is a minimally invasive endoscopic technique, increasingly used to treat lower-GI conditions. OBJECTIVE: To evaluate the efficacy and safety of a PEC tube insertion at a single unit. DESIGN: Retrospective data collection. SETTING: District general and teaching hospital in the United Kingdom. PATIENTS: Data collected from patients with lower-GI disorders who had a PEC tube inserted. INTERVENTIONS: Data collection. MAIN OUTCOME MEASUREMENTS: Incidence of complications and patient outcome. RESULTS: Between 2001 and 2005, 31 patients presented for a PEC. Insertion was possible in 27 patients. Indications included functional constipation (n=8), recurrent sigmoid volvulus (n=8), colonic pseudo-obstruction (n=5), and neurologic constipation (n=6). In 22 patients (81%), symptoms were markedly improved after insertion. Sigmoid volvulus did not recur with a PEC tube in place. The mean (standard error of the mean) duration with tubes in situ was 9.5+/-1.6 months. Only 2 patients still had a PEC tube in situ. A total of 77% of patients had episodes of infection. Infective episodes led to tube removal in 44% of the total group. Other complications included buried internal bolster, fecal leakage, and pain. Mortality was high (26%), with 7 deaths: 5 from unrelated causes and 2 deaths from fecal peritonitis. LIMITATIONS: This was a retrospective study. A prospective study in our unit is unlikely because of these results. CONCLUSIONS: Symptoms were effectively controlled by a PEC tube insertion, and recurrent sigmoid volvulus was prevented. Recurrent complications caused significant morbidity. Infection necessitated tube removal in the majority of patients. Fatal fecal peritonitis occurred in 2 patients. Indiscriminate use of a PEC in the left side of the colon is not recommended. A PEC should only be considered in carefully selected cases. Published 28 May 2007 in Gastrointest Endosc, 65(7): 1007-14.
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