Volvulus of the Sigmoid Colon Treated by Percutaneous Endoscopic Colostomy

Abstract

Volvulus of the sigmoid colon is a condition that, in the Western world, predominately affects the elderly. In fit patients sigmoid colectomy, after a period of decompression, is the treatment of choice. However, this carries a high mortality in elderly high-risk patients. Percutaneous endoscopic colostomy (PEC) has been reported as a treatment for those who are considered high risk for surgery. We report the successful use of PEC in an 87-year-old lady, for the treatment of recurrent sigmoid volvulus, without complication. This procedure has also been used effectively for colonic pseudo-obstruction, constipation, and obstructed defecation. There are various complications associated with PEC, the most serious of which is tube migration and fecal peritonitis. Our experience supports the use of PEC to treat sigmoid volvulus in those too frail for colonic resection.

Percutaneous endoscopic colostomy for adults with chronic constipation: Retrospective case series of 12 patients

“…70‐75 years and 79‐80 years). Higher ages were also reported by other studies on pseudo‐obstruction and volvulus . Mean age of our population was 56 years, significantly younger and probably less frail than the patients undergoing PEC for volvulus or pseudo‐obstruction.…”

Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review

“…This did not result in any subsequent relapse, perhaps suggesting that adhesions slowly form between the sigmoid colon and the anterior abdominal wall to prevent further episodes of sigmoid volvulus even after PEC tube removal. The majority of patients found having a long-term PEC tube in situ acceptable 3 7 and, therefore, from the current evidence we would recommend keeping 2 PEC tubes in situ indefinitely.…”

“…The length of follow up described was variable, the shortest being 3 months 3 and the longest 89 months 11. …”

“…Sigmoid volvulus occurs when the sigmoid colon twists on its mesenteric axis 2. The patient demographic varies across the world, however, in Western populations, patients tend to be elderly with significant comorbidities 3. Predisposing factors for sigmoid volvulus are thought to be a long redundant loop of sigmoid colon with an elongated mesentery 4, chronic constipation, and neurological diseases 5.…”

Volvulus of the sigmoid colon

“…Elective resection of the sigmoid colon and anastomosis (ELRSA) is the gold standard with a mean mortality of 8% (range 0–15%), a mean recurrence of 1.2% (range 0–20%) and a morbidity of 13–26% [2,91,101]. Nonresective alternatives include open or laparoscopic sigmoidopexy, endoscopic T‐fastener fixation [106], tube sigmoidostomy [107], extraperitonealization of the colon [108], mesocoloplasty [109,110], sigmoid plication [58], Ladd’s procedure [111] and percutaneous endoscopic colostomy (PEC) [112–114]. In the absence of randomized controlled studies, it is difficult to advocate any one in particular.…”