CT-guided percutaneous catheter cecostomy

Abstract

A patient with pseudomembranous colitis is described in whom a percutaneous cecostomy was performed using computed tomographic guidance. Several lines of evidence indicate the safety of this approach, and clinical circumstances are suggested in which the procedure may have potential therapeutic benefit.

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

“…At present the primary surgical strategy is to resect the megacolon, uncontrolled bleeding, and perforation [17,48,76,78,130,[176][177][178][179]. In a 10-year prospective study, damaged bowel and create a protective proximal stoma [7,17].…”

Percutaneous bowel drainage for jaundice due to afferent loop obstruction following pancreatoduodenectomy: Report of a case

“…Laboratory studies thus suggested a probability of peritoneal contamination with percutaneous drainage. No major peritoneal complications have been reported in the literature, [5][6][7][8][9][10][11][12][13] although the reason for this is unclear. If the bowel contents at the puncture site had been gas, then its leakage would not have caused peritonitis.…”

“…14 No major fecal leakage into the peritoneal cavity in a clinical case has yet been reported in the literature. [5][6][7][8][9][10][11][12][13] Magiot and Cascade 12 reported sepsis due to gas producing cellulitis around the drainage tube (8.5 F Cope type, Seldinger's method) resulting in death following cecal decompression in a patient with Ogilvie's syndrome. Mortensen et al 11 reported septicemia which was treated conservatively in a case of Ogilvie's syndrome, although the exact cause of sepsis was not documented.…”

“…Percutaneous catheter cecostomy has been reported in cases of mechanical large bowel obstruction, 6 Ogilvie's syndrome, 7-12 and cecal volvulus. 13 The catheters used in these reported cases varied widely, consisting of: Forey, pig tail, Malecot, Ingram, and Cope-type nephrostomy catheters of various bore sizes, 5-12 F, [5][6][7][8][9][10][11][12][13] which were all equipped with retention devices to hold the intestine tightly against the anterior abdominal wall. The techniques also differed between and within the studies; 5-13 trocar, Seldinger, and a blind incision of the colon.…”

“…6 Ultrasound, fluorescence, and CT were used for guidance. [5][6][7][8][9][10][11][12][13] The immediate concern is peritoneal contamination with catheter drainage for the obstructed bowel with an elevated intraluminal pressure to 30-60 mmHg. 14 No major fecal leakage into the peritoneal cavity in a clinical case has yet been reported in the literature.…”