Percutaneous endoscopic colostomy (PEC)

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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

stabilizes colonic position, "fixing" it in place (cf. colopexy)

Indications

recurrent sigmoid volvulus
colonic pseudo-obstruction
megacolon
constipatory/defecatory problems refractory to standard treatments

Contraindications

abdominal wall infection/sepsis
ischemic 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) .