Endoscopic treatment of recurrent sigmoid volvulus with colopexy assisted by T-fasteners and colostomy.

T-fasteners havebeenused successfully for percutaneous endoscopic sigmoidopexy [1]; however, peritonitismaydevelop after percutaneous endoscopic sigmoidostomy [2]. We present a patient with recurrent sigmoid volvulus who was treated endoscopically by sigmoidopexy assisted by T-fasteners and sigmoidostomy. A 95-year-old man was hospitalized five times between July 2013 and February 2015 because of recurrent sigmoid volvulus. Surgery was not an option owing to patient co-morbidity, so a combined endoscopic approach, involving colopexy and colostomy, was proposed. Following bowel preparation, colonoscopy was carried out in the endoscopy suite with thepatient in the supineposition, under deep sedation andwith antibiotic prophylaxis. The colon was insufflated with air. Abdominal wall transillumination at 28cm from the anal margin allowed an appropriate colopexy site to be selected from the sigmoid colon. Externally, a 21-G needlewas used to ensure the appropriate location and direction before placement of a T-fastener to fix the sigmoid colon to the abdominal wall. A total of four T-fasteners were placed in a square arrangement (●" Fig.1,●" Video 1). A small incision was then made using a surgical blade, and a 19-G trocar needle and a guidewire were inserted into the colon. Progressive dilations were performed to create a stoma tract (●" Fig.2). Finally, a 20-Fr gastrostomy tubewas placed using the “push” technique (●" Fig.3). A 2–3mm colonic perforation was immediately seen (●" Fig.4), and was closed using four clips and two endoloops (●" Fig.5). The patient was discharged from hospital 2 days later. After 17 days, the suture locks released spontaneously. The patient died 10 months later from pneumonia, without recurrence of volvulus. Fig.1 T-fasteners with the suture locks closed at the abdominal wall. Fig.2 Serial dilator advanced over a guidewire into the colon. a External view. b Endoscopic view.