Percutaneous endoscopic cecostomy in adults: a case series

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 at 4 days for fecal spillage resulting in peritonitis despite successful percutaneous endoscopic cecostomy 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.