Percutaneous Endoscopic Colostomy of the Left Colon: A New Technique for the Management of Intractable Chronic Constipation

Abstract

Background and Purpose:

A variety of methods have been devised over the past decade to overcome constipation secondary to slow distal colonic transit when traditional medical therapy has failed. We describe a new technique for the administration of antegrade colonic enemas in children with this condition.

Patients and Methods:

Six children (aged 4-15 years) were selected over an 18-month period with a range diagnoses including Hirschsprung's disease, anorectal anomaly, and idiopathic chronic constipation. All the children were soiling, had failed to improve despite prolonged courses of high-dose oral laxatives, and had confirmed slow distal colonic transit. The length of treatment preoperatively ranged from 3 to 13 years. The surgical technique consisted of a method similar to that for percutaneous gastrostomy, with the tubular device being inserted under endoscopic guidance into the left colon at the junction of descending and sigmoid colon.

Results:

Patients were assessed using a "clean score." All showed significant improvement at 2-month follow-up. At longer-term follow-up, two had normal bowel habits, a further three had a sustained benefit, and one had abandoned the device, as it was no longer beneficial.

Conclusion:

This new technique is a relatively simple alternative to the established methods of delivering an antegrade enema, requiring a shorter postoperative hospital stay. Success has been achieved despite long preoperative periods with failed therapy in this select group of children.