Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience.

Abstract

Percutaneous cecostomy (PCC) was evaluated in dogs and cadavers and by means of review of intraperitoneal contrast material-enhanced computed tomographic (CT) scans and clinical experience in five patients with Ogilvie syndrome. It was shown that PCC can be accomplished with a variety of techniques (e.g. Seldinger or trocar puncture, tacking) and instruments (various types and sizes of retention and nonretention catheters). Anatomic studies revealed that the cecum is surrounded by the peritoneum for as much as 270 degrees of its circumference, so that a retroperitoneal approach to PCC would probably be unfeasible in most patients. PCC was effective in treating all five patients in this study, despite their advanced age and complicated medical conditions. Decompression of colonic gas was achieved with 8-12-F catheters, and no major complications occurred. Endoscopic decompression had been unsuccessfully attempted in four of the patients previously. It is concluded that PCC may be an important option in the treatment of Ogilvie syndrome and that the procedure may obviate surgery and be lifesaving in certain high-risk patients.

Acute colonic pseudo-obstruction

“…[45][46][47] A recently published small case series described 5 patients (2 patients with ACPO) in which percutaneous endoscopic cecostomy was the definitive treatment. 47 This approach is modelled after the percutaneous endoscopic gastrostomy pull technique.…”

The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction

“…[85][86][87] PEC of the cecum has been described in multiple small case-series and can be performed either though a combined endoscopic and radiologic approach or in a manner analogous to placement of a percutaneous endoscopic gastrostomy tube. [88][89][90][91][92] Although PEC of the cecum has had relatively favorable outcomes, results are discouraging for left-side colon PEC, with one study reporting infection in 77% of 31 patients. 85 This approach has typically been reserved for patients with recurrent or refractory ACPO.…”

Acute colonic pseudo-obstruction (Ogilvie’s syndrome)

“…In the absence of ischemia or perforation, a simple surgical cecostomy can be performed under local anesthesia. As an alternative, percutaneous cecostomy can be accomplished by a Seldinger puncture guided by laparoscopy, ultrasonography, or radiography [43]. Catheter cecostomy requires a vigorous postoperative follow-up to ensure adequate function and minimal morbidity.…”

“…• Exploratory laparotomy is indicated in patients with massive cecal distention presenting with pneumoperitoneum, development of peritonitis, respiratory failure, and diagnostic uncertainty. Reported overall mortality rate of surgical procedures in patients with acute colonic pseudo-obstruction is as high as 10% to 15% [42][43][44][45].…”