Online Articles: Case ReportsEndoscopic-assisted Colopexy and Push Percutaneous Colostomy in the Transverse Colon for Refractory Chronic Intestinal pseudo-ObstructionMolina-Infante, Javier MD; Mateos-Rodriguez, Jose M. MD; Vinagre-Rodriguez, Gema MD; Martin-Noguerol, Elisa MD; Gonzalez Santiago, Jesus M. MD Author Information Unit of Gastroenterology, Hospital San Pedro de Alcántara, Caceres, Spain The authors decalre no conflicts of interest. Reprints: Javier Molina Infante, MD, Unit of Gastroenterology, Hospital San Pedro de Alcántara, Caceres, Spain, Pablo Naranjo s/n 10003 Caceres, Spain (e-mail: [email protected]). Received September 7, 2010 Accepted August 5, 2011 Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 21(6):p e322-e325, December 2011. | DOI: 10.1097/SLE.0b013e3182319a9e Buy Metrics Abstract Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy. © 2011 Lippincott Williams & Wilkins, Inc.