Abstract
A 75-year-old man was admitted for abdominal distension and vomiting. A plain abdominal X-ray films and the computed tomography (CT) scan showed marked dilatation of the colon and incarcerated incisional hernia. A maximum diameter of the colon was 15cm. After the conservative management with long tube for intestinal obstruction, the operation for incisional hernia was performed. Even after the operation, the patient couldn't stand up by himself after meals due to marked abdominal distension. The colonoscopy revealed that the dilatation of only transverse colon and no stricture or local recurrence of colon cancer. Some kinds of laxatives and other medicines were not effective. Percutaneous endoscopic transverse colostomy (PEC) was performed under local anesthesia because of refuse for transverse colectomy or colostomy. The postoperative course is satisfactory without complication. After decompression of massive gas in the transverse colon, patient's abdominal distension was disappeared. The patient's activities of daily living (ADL) were improved. Although PEC is an effective management for colonic pseudo-obstruction, on the other hand, some serious complications including fecal peritonitis were reported. It must be noted that PEC should only be considered in carefully selected cases. To my knowledge, there has been no report of the percutaneous endoscopic colostomy of the transverse colon.
