Laparoscopy-Assisted PEC Tubes: A Novel Treatment for Sigmoid Volvulus

Introduction: In the United States, sigmoid volvulus is frequently seen in the elderly and neurologically impaired, driving a search for less invasive but effective treatments that may obviate the need for resection. This case study describes a novel technique for sigmoidopexy: a modified endoscopic approach for percutaneous endoscopic colostomy (PEC) tube placement in combination with laparoscopy for safety. Case Description: This is a case study reporting a novel technique. The subject was a 55-year-old man with a history of longstanding constipation and recurrent sigmoid volvulus. Because of religious beliefs, the family refused any surgical procedures requiring bowel resection. Thus, alternative methods for definitive treatment were sought. The patient underwent laparoscopic assisted PEC tube placement with placement of three colostomy tubes for sigmoidopexy. The procedure was tolerated well, and the patient had an uneventful postoperative course. With persistent symptoms of constipation and dysmotility, the colon could be vented and irrigated via the colostomy tubes. Two years after surgery the patient has all 3 PEC tubes in place without complication or recurrence of sigmoid volvulus. Conclusion: PEC tubes have been used for sigmoidopexy with various levels of success in the treatment of recurrent volvulus, but laparoscopic assistance in placement of 3 PEC tubes has not been documented. Laparoscopic assistance allows for reduction of volvulus and decreases complications associated with PEC tube placement. This case demonstrates a novel, safe technique for the treatment of sigmoid volvulus.