Percutaneous endoscopic colostomy of the left colon: A new technique for the management of intractable chronic constipation

摘要

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.