Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: a case report and review of the literature

Abstract

Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient's quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.

Figure 1

CT-scan showing massive distension of the colon (but not of the small intestine).

Figure 2

Endoscopic view of the left colon. A 19-gauge needle grasped with an endoscopic snare (arrow) serves to hold the colon close to the abdominal wall while a string is passed through a Seldinger needle (arrowhead) to allow for transanal insertion of the colostomy tube.

Figure 3

CT-scan showing the colostomy tube in place (arrow) and a normal-appearing colon.

Figure 4

Abdominal plain X-ray showing a massive pneumoperitoneum.