Molina-Infante Javier, Mateos-Rodriguez Jose M, Vinagre-Rodriguez Gema, Martin-Noguerol Elisa, Santiago Jesus M Gonzalez
Unit of Gastroenterology, Hospital San Pedro de Alcántara, Caceres, Spain.
Surg Laparosc Endosc Percutan Tech. 2011 Dec;21(6):e322-5. doi: 10.1097/SLE.0b013e3182319a9e.
Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy.
经皮内镜下结肠造口术（PEC），采用经典的拖出技术在升结肠或降结肠进行，已被证明对治疗慢性肠梗阻有效。我们报告了一例手术风险高的70岁男性难治性慢性肠梗阻患者，由于左结肠冗长迂曲，无法到达升结肠。因此决定在近端横结肠进行内镜辅助结肠固定术和推式结肠造口术。在近端横结肠直视下，使用3个预加载的T形钉围绕预定的造口部位进行结肠固定术。用穿刺针建立造口通道，使24F 4套管扩张器能在导丝上推进。之后，取出扩张器，留置可剥离鞘。通过覆盖物，在导丝引导下将一根20F胃造瘘管推进结肠腔，最后取出覆盖物。尽管术后出现与手术技术相关的气腹，但患者恢复顺利。他一个月后因无关的合并症死亡，出院后无进一步腹部不适。这是首例采用推式技术的PEC报告，也是首例在升结肠或降结肠以外部位的报告。我们认为这种新型推式技术可能对PEC可行，避免了结肠镜检查困难患者重新插入的需要。
