Mohamad Salmi, Muhammad Irfan and Kodiron, Muhammad Afiq and Md Nor, Azmi and Elagili, Faisal (2026) Percutaneous endoscopic colostomy for morbid obesity with chronic intestinal pseudo-obstruction: technical challenges and long-term outcomes. World Journal of Colorectal Surgery, 15 (1). pp. 24-26. E-ISSN 1941-8213
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Abstract
Chronic intestinal pseudo-obstruction (CIPO) is a rare motility disorder, with recurrent sigmoid volvulus as a possible life-threatening complication. Surgical resection is curative; however, this is rarely possible in high-risk patients. A 68-year-old man, with a body mass index (BMI) of 52 kg/m² and multiple comorbidities, presented with recurrent sigmoid volvulus on a CIPO background. He had multiple colonoscopic decompressions, which only provided temporary relief. Given the high anesthetic risk, a percutaneous endoscopic colostomy (PEC) was performed under propofol sedation and a transversus abdominis plane block. Technical challenges included a thick abdominal wall, leading to poor endoscopic transillumination. This was overcome using a combination of transillumination, finger indentation, and the dark-room technique. Two 24 Fr PEC tubes were placed 4 cm apart in the right lumbar region, achieving immediate decompression. The post-procedural course was uneventful, with complete symptom resolution and no recurrence at 18-month follow-up. In morbidly obese patients with CIPO and recurrent volvulus, PEC can be performed safely with appropriate technical modifications. This case is the first highlighting weight and obesity and contributes to the PEC literature, while reaffirming PEC’s role as a minimally invasive procedure for patients who are surgically unfit
| Item Type: | Article (Case Report) |
|---|---|
| Uncontrolled Keywords: | Obesity, percutaneous colostomy, technical, volvulus |
| Subjects: | R Medicine > RD Surgery |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine > Department of Surgery Sultan Ahmad Shah Medical Centre (SASMEC) |
| Depositing User: | Dr Muhammad Irfan Mohamad Salmi |
| Date Deposited: | 01 Apr 2026 16:03 |
| Last Modified: | 01 Apr 2026 16:03 |
| Queue Number: | 2026-04-Q2711 |
| URI: | http://irep.iium.edu.my/id/eprint/128148 |
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