Percutaneous endoscopic colostomy (PEC) is a procedure used to treat recurrent sigmoid volvulus and large bowel dysmotility (e.g. pseudo-obstruction) in those individuals deemed too high risk for conventional surgery, or for whom standard therapies have failed to provide adequate improvement.
It is thought that the mechanism by which percutaneous endoscopic colostomy works is two-fold:
- conduit to decompress/wash-out colon
- stabilises colonic position, "fixing" it in place (cf. colopexy)
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Indications
- recurrent sigmoid volvulus
- colonic pseudo-obstruction
- megacolon
- constipatory/defaecatory problems refractory to standard treatments
Contraindications
- abdominal wall infection/sepsis
- ischaemic colitis
- bowel obstruction
Procedure
The technique is very similar to inserting a PEG. It uses a colonoscope to reach the desired point in the colon for the percutaneous endoscopic colostomy (PEC) tube. The light on the endoscope transilluminates the skin overlying the colon and the PEC is inserted percutaneously at this location.
Complications
- peritonitis
- colonic perforation
- infection
- pain at the insertion site
- leakage from PEC
- tubal erosion
- granuloma formation
History and etymology
Percutaneous endoscopic colostomy was originally described in 1986 by Jeffrey L Ponsky, an American endoscopic surgeon, who had previously been the co-developer of percutaneous endoscopic gastrostomy (PEG) 1,2.