An 80-year-old woman with a history of dementia and constipation was hospitalized
three times within 3 years for recurrent episodes of sigmoid volvulus. As this patient
was at high risk of surgical complications, a minimally invasive strategy (i. e. endoscopic
sigmoidopexy), was decided after multidisciplinary discussion. In addition to previously
described methods of endoscopic sigmoidopexy [1], we proposed to implant a Chait cecostomy catheter (Cook Medical, Bloomington, Indiana,
USA) ([Video 1]), as for patients treated by percutaneous endoscopic cecostomy for severe constipation
[2]
[3].
Video 1 Endoscopic sigmoidopexy with placement of a Chait catheter for recurrent sigmoid
volvulus.
Under sedation and after enhanced bowel preparation and antibiotic prophylaxis, a
colonoscopy was performed by the first operator. On reaching the sigmoid flexure,
transillumination and abdominal wall finger test in sterile conditions were used by
the second operator to define the optimal site for catheter placement. Local anesthesia
using ropivacaine was performed with a subcutaneous needle and confirmed the feasibility
of percutaneous access under endoscopic guidance. Three anchors were then placed to
fix the sigmoid to the abdominal wall ([Fig. 1]). After making a small skin incision, a trocar needle was inserted in the center
of the anchors and an 80-cm guidewire was placed through the trocar, which was then
removed. Over the guidewire, three dilators 6, 8, and 10 Fr were introduced consecutively
allowing subsequent placement of the Chait catheter ([Fig. 2]).
Fig. 1 Endoscopic view of the procedure. a Anchors. b Chait catheter.
Fig. 2 The patient’s abdomen at 1 year follow-up.
The patient was discharged the following day and returned 2 weeks later to undergo
colonic antegrade enema and thus check catheter permeability. No postoperative complications
occurred and the catheter tolerance was good. At 1-year follow-up, the patient had
no recurrence of volvulus.
Endoscopic sigmoidopexy with placement of a Chait catheter could be a promising method
to prevent recurrence of sigmoid volvulus in patients with contraindication to surgery,
as it provides not only bowel fixation but also allows on-demand colonic enemas or
decompression.
Endoscopy_UCTN_Code_TTT_1AQ_2AJ
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
